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General NPI Number Information
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NPI Number | 1043888985
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Entity Type | Organization
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Legal Business Name | MAGNIFYDX LLC
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Dates
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Enumeration Date | 06/16/2021
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Last Update Date | 08/07/2024
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Provider Practice Location Address
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Address Line | 100 EXECUTIVE WAY STE 114
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City | PONTE VEDRA BEACH
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State | FL
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Zip | 32082-2713
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Country | US
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Telephone | 904-842-3632
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Fax |
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Provider Business Mailing Address
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Address Line | 100 EXECUTIVE WAY STE 114
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City | PONTE VEDRA BEACH
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State | FL
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Zip | 32082-2713
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Country | US
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Telephone | 904-842-3632
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Fax | 877-624-3376
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Authorized Official
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Title or Position | OWNER
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Name | MARK CAPPEL
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Credential | MD
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Telephone | 904-686-7771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207ND0900X
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Taxonomy Name | Dermatopathology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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