Healthcare Provider Details

I. General information

NPI: 1588682728
Provider Name (Legal Business Name): JOSEPH G MAGNANT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 10/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 ROYAL PALM SQUARE BLVD SUITE 101
FORT MYERS FL
33919-1068
US

IV. Provider business mailing address

1510 ROYAL PALM SQUARE BLVD SUITE 101
FORT MYERS FL
33919-1068
US

V. Phone/Fax

Practice location:
  • Phone: 239-694-8346
  • Fax: 239-936-6272
Mailing address:
  • Phone: 239-694-8346
  • Fax: 239-936-6272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberME94904
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: