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General NPI Number Information
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NPI Number | 1831304328
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Entity Type | Organization
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Legal Business Name | CHAD MAGNUSON MD PLLC
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 17429 VASHON HIGHWAY SW
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City | VASHON
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State | WA
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Zip | 98070-4653
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Country | US
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Telephone | 206-463-5401
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1450
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City | VASHON
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State | WA
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Zip | 98070-1450
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Country | US
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Telephone | 206-463-5401
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHAD RAYMOND MAGNUSON
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Credential | M.D.
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Telephone | 206-463-4404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State | WA
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