Provider Demographics
NPI:1831304328
Name:CHAD MAGNUSON MD PLLC
Entity Type:Organization
Organization Name:CHAD MAGNUSON MD PLLC
Other - Org Name:CHAD MAGNUSON FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:MAGNUSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-463-4404
Mailing Address - Street 1:PO BOX 1450
Mailing Address - Street 2:
Mailing Address - City:VASHON
Mailing Address - State:WA
Mailing Address - Zip Code:98070-1450
Mailing Address - Country:US
Mailing Address - Phone:206-463-5401
Mailing Address - Fax:
Practice Address - Street 1:17429 VASHON HIGHWAY SW
Practice Address - Street 2:
Practice Address - City:VASHON
Practice Address - State:WA
Practice Address - Zip Code:98070-4653
Practice Address - Country:US
Practice Address - Phone:206-463-5401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care