Basic Information
| Provider Information | |||||||||
| NPI: | 1811382955 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAGAR | ||||||||
| FirstName: | JAMIE | ||||||||
| MiddleName: | DON | ||||||||
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| Credential: | ATP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5501 WILSHIRE AVE NE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871132569 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5053386100 | ||||||||
| FaxNumber: | 5053596774 | ||||||||
| Practice Location | |||||||||
| Address1: | 5501 WILSHIRE AVE NE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871132569 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5053386100 | ||||||||
| FaxNumber: | 5053596774 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2015 | ||||||||
| LastUpdateDate: | 04/06/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 247200000X | Y | Technologists, Technicians & Other Technical Service Providers | Technician, Other |
No ID Information.