MEDICARE: JEFFERY S MAGNUSON MD

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	207Y00000X	Otolaryngology Physician	19372	AL
2	207Y00000X	Otolaryngology Physician	ME113411	FL
3	207YX0905X	Otolaryngology/Facial Plastic Surgery Physician	ME113411	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	051517997	OTHER	AL	BLUE CROSS
3	000020880	OTHER	AL	BLUE CROSS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	G31208	OTHER	AL	VIVA

General Provider Information

NPI Number	:	1891727418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFERY S MAGNUSON MD

Provider Business Mailing Address
First Line	:	410 CELEBRATION PL
Second Line	:	SUITE 305
City	:	CELEBRATION
State	:	FL
Zip	:	34747-5433
Country	:	US
Telephone Number	:	407-303-4120
Fax Number	:	407-303-4124

Provider Business Practice Location Address
First Line	:	410 CELEBRATION PL
Second Line	:	SUITE 305
City	:	CELEBRATION
State	:	FL
Zip	:	34747-5433
Country	:	US
Telephone Number	:	407-303-4120
Fax Number	:	407-303-4124

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

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	08/20/2019

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Directions to “ JEFFERY S MAGNUSON MD” Practice Location

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