Provider Demographics
NPI:1124205349
Name:VEIN SPECIALISTS AT ROYAL PALM SQUARE INC
Entity Type:Organization
Organization Name:VEIN SPECIALISTS AT ROYAL PALM SQUARE INC
Other - Org Name:JOSEPH G. MAGNANT, MD
Other - Org Type:Other Name
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:MAGNANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-694-8346
Mailing Address - Street 1:1510 ROYAL PALM SQUARE BLVD
Mailing Address - Street 2:STE. 101
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-1068
Mailing Address - Country:US
Mailing Address - Phone:239-694-8346
Mailing Address - Fax:239-936-6272
Practice Address - Street 1:1510 ROYAL PALM SQUARE BLVD
Practice Address - Street 2:STE. 101
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-1068
Practice Address - Country:US
Practice Address - Phone:239-694-8346
Practice Address - Fax:239-936-6272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-30
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME949042086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1588682728OtherNPI
FL1588682728OtherNPI
FLE67570Medicare UPIN