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Individual
JUDITH MARIE MAGO
Active
Individual
JUDITH MARIE MAGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1501352
KS
363A00000X
Physician Assistant
872
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
111003004
BCBS
KS
05
—
200631060A
—
KS
Enumeration date
10/04/2006
Last updated
02/05/2015
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