Provider Demographics
NPI:1588682728
Name:MAGNANT, JOSEPH G (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:G
Last Name:MAGNANT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1510 ROYAL PALM SQUARE BLVD
Mailing Address - Street 2:SUITE 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:SUITE 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME949042086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1124205349OtherFACILITY NPI
FLME94904OtherSTATE LICENSE
FL1124205349OtherFACILITY NPI
FLME94904OtherSTATE LICENSE