MEDICARE: DR. SCOTT A. MAGNES M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	25400	IA

General Provider Information

NPI Number	:	1164409967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT A. MAGNES M.D.

Provider Business Mailing Address
First Line	:	PO BOX 555191
Second Line	:	BLDG. H100, ATTENTION: CODE 094
City	:	CAMP PENDLETON
State	:	CA
Zip	:	92055-5191
Country	:	US
Telephone Number	:	760-725-1370
Fax Number	:	760-725-0051

Provider Business Practice Location Address
First Line	:	1536 N JEFFERSON ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32209-6525
Country	:	US
Telephone Number	:	904-475-5800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	10/20/2022

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