Provider Demographics
NPI:1093742702
Name:MAGNUSSON, JAMES E (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:MAGNUSSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 39
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-0039
Mailing Address - Country:US
Mailing Address - Phone:405-321-3499
Mailing Address - Fax:405-364-5379
Practice Address - Street 1:2404 PALMER CIR
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6301
Practice Address - Country:US
Practice Address - Phone:405-579-9400
Practice Address - Fax:405-579-9499
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK27132086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKF84015Medicare UPIN