Organization
MAGNOLIA EMERGENCY PHYSICIANS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY BYRNE M.D. (PRESIDENT)
(469) 401-2386
Entity
Organization
Contact information
Practice address
1500 SW 1ST AVE, OCALA, FL 34471-6504
(352) 351-3407
(352) 351-7602
Mailing address
13737 NOEL RD, STE 1600, DALLAS, TX 75240-1331
(469) 401-2386
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
260431100
—
FL
01
—
45624
BLUE SHIELD
FL
Enumeration date
05/08/2006
Last updated
10/02/2017
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