Doctor Name: | DR. THOMAS RYAN MAGRA |
NPI Number: | 1063560183 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 0101240248 |
Business Practice Address: | 650 Joel Dr Blanchfield Army Community Hospital Fort Campbell, KY - 422235318 |
Business Phone Number: | 2704612333 |
Business Fax Number: | |
Mailing Address: | 650 Joel Dr, Blanchfield Army Community Hospital FORT CAMPBELL |
State: | KY |
Postal Code: | 422235318 |
Phone Number: | 2704612333 |
Fax Number: | |
NPI Enumeration Date: | 01/08/2007 |
NPI Last Update Date: | 09/23/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 171000000X |
License Number: | 0101240248 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | VA |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Military Health Care Provider |
Taxonomy Specialization: | |
Taxonomy Definition: | Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes. |