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NPI Code Detail

MEDICARE: DEREK DOUGLAS MAGNUSON PA-C

MEDICARE: DEREK DOUGLAS MAGNUSON PA-C
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
1363A00000XPhysician AssistantPA9101889FL
2363AM0700XMedical Physician AssistantPA9101889FL

General Provider Information

NPI Number : 1124115126
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEREK DOUGLAS MAGNUSON PA-C
Provider Business Mailing Address
First Line : 7550 N DALE MABRY HWY
Second Line :
City : TAMPA
State : FL
Zip : 33614-3226
Country : US
Telephone Number : 813-885-4706
Fax Number : 813-885-9463
Provider Business Practice Location Address
First Line : 7550 N DALE MABRY HWY
Second Line :
City : TAMPA
State : FL
Zip : 33614-3226
Country : US
Telephone Number : 813-885-4706
Fax Number : 813-885-9463
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2006
Last Update Date : 01/22/2021

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Directions to “ DEREK DOUGLAS MAGNUSON PA-C” Practice Location

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