Provider Demographics
NPI:1164595914
Name:MAGNUSSON, PETER TOD (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:TOD
Last Name:MAGNUSSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:185 E 7TH AVE STE C
Mailing Address - Street 2:SUITE C
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-3356
Mailing Address - Country:US
Mailing Address - Phone:530-893-4393
Mailing Address - Fax:530-893-1543
Practice Address - Street 1:185 E 7TH AVE STE C
Practice Address - Street 2:SUITE C
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-3356
Practice Address - Country:US
Practice Address - Phone:530-893-4393
Practice Address - Fax:530-893-1543
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2011-10-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG21743207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA41365Medicare ID - Type Unspecified