Individual
JAMES R. MAGNUSSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
90 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 446-5415
(740) 446-5958
Mailing address
90 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 446-5415
(740) 446-5958
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
13013
WV
207Y00000X
Otolaryngology Physician
Primary
35-03-4973
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000006800
ANTHEM BCBS
—
01
—
000000181417
UNISON MEDICAID
OH
01
—
001714044
MOUNTAIN STATE BCBS
—
05
—
0101035000
—
WV
01
—
0366376
MOLINA MEDICAID
OH
05
—
0366376
—
OH
01
—
040003160
RR MEDICARE
—
01
—
310917085093
CARESOURCE MEDICAID
OH
Enumeration date
05/19/2006
Last updated
10/24/2011
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