Basic Information
| Provider Information | |||||||||
| NPI: | 1760427447 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DR JAMES MAGNUSSON INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 39 | ||||||||
| Address2: | |||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730700039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053213499 | ||||||||
| FaxNumber: | 4053645379 | ||||||||
| Practice Location | |||||||||
| Address1: | 2404 PALMER CIR | ||||||||
| Address2: | |||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730696301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4055799400 | ||||||||
| FaxNumber: | 4055799499 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2006 | ||||||||
| LastUpdateDate: | 07/30/2008 | ||||||||
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| AuthorizedOfficialLastName: | MAGNUSSON | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4055799400 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0122X | 2713 | OK | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Plastic and Reconstructive Surgery |
ID Information
| ID | Type | State | Issuer | Description | 200127200A | 05 | OK | MEDICAID |