MEDICARE: DR. JOSEPH G MAGNANT M.D.

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
1	2086S0129X	Vascular Surgery Physician	ME94904	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1124205349	OTHER	FL	FACILITY NPI
2	ME94904	OTHER	FL	STATE LICENSE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588682728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH G MAGNANT M.D.

Provider Business Mailing Address
First Line	:	1510 ROYAL PALM SQUARE BLVD
Second Line	:	SUITE 101
City	:	FORT MYERS
State	:	FL
Zip	:	33919-1068
Country	:	US
Telephone Number	:	239-694-8346
Fax Number	:	239-936-6272

Provider Business Practice Location Address
First Line	:	1510 ROYAL PALM SQUARE BLVD
Second Line	:	SUITE 101
City	:	FORT MYERS
State	:	FL
Zip	:	33919-1068
Country	:	US
Telephone Number	:	239-694-8346
Fax Number	:	239-936-6272

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	10/07/2008

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