Provider Demographics
NPI:1558492231
Name:MAGNUSON, LARRY WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:WAYNE
Last Name:MAGNUSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:282 SEDRO TRL
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-2021
Mailing Address - Country:US
Mailing Address - Phone:512-773-5511
Mailing Address - Fax:512-869-2420
Practice Address - Street 1:2825 INTERSTATE 10 E
Practice Address - Street 2:STE 105
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1013
Practice Address - Country:US
Practice Address - Phone:409-896-2373
Practice Address - Fax:409-896-2337
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG10882083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine