Healthcare Provider Details

I. General information

NPI: 1164409967
Provider Name (Legal Business Name): SCOTT A. MAGNES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1536 N JEFFERSON ST
JACKSONVILLE FL
32209-6525
US

IV. Provider business mailing address

PO BOX 555191 BLDG. H100, ATTENTION: CODE 094
CAMP PENDLETON CA
92055-5191
US

V. Phone/Fax

Practice location:
  • Phone: 904-475-5800
  • Fax:
Mailing address:
  • Phone: 760-725-1370
  • Fax: 760-725-0051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number25400
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: