Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 19372 | AL |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | ME113411 | FL |
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | ME113411 | FL |
NPI | 1891727418 |
---|---|
Provider Name | Jeffery S Magnuson |
First Address | Celebration, FL 34747-5433 |
Second Address | Celebration, FL 34747-5433 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 20/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000020880 | (05) | AL |
000020880 | BLUE CROSS (01) | AL |
009965835 | (05) | AL |
051517997 | BLUE CROSS (01) | AL |
G31208 | VIVA (01) | AL |