Provider Demographics
NPI:1760427447
Name:DR JAMES MAGNUSSON INC
Entity Type:Organization
Organization Name:DR JAMES MAGNUSSON INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:MAGNUSSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:405-579-9400
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK27132086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200127200AMedicaid
OK200127200AMedicaid