Provider Demographics
NPI:1144355892
Name:MARTIN E MCGONAGLE MD PA
Entity type:Organization
Organization Name:MARTIN E MCGONAGLE MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCGONAGLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PA
Authorized Official - Phone:254-965-7870
Mailing Address - Street 1:510 E HWY 377
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-2556
Mailing Address - Country:US
Mailing Address - Phone:817-579-2662
Mailing Address - Fax:817-579-2663
Practice Address - Street 1:107 S PARK DR
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-5951
Practice Address - Country:US
Practice Address - Phone:325-643-5824
Practice Address - Fax:325-643-1256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126628005Medicaid
531518OtherBLUE CROSS BLUE SHIELD
TX126628005Medicaid
531518OtherBLUE CROSS BLUE SHIELD