Individual
JOHN J MAGNUSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
155 VILLAGE DR, SPARTA, MO 65753-8104
(417) 634-4203
(417) 634-4505
Mailing address
155 VILLAGE DR, SPARTA, MO 65753-8104
(417) 634-4203
(417) 634-4505
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
2002019251
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1770689747
—
MO
05
—
205921703
—
MO
01
—
P00361139
RR MEDICARE
—
Enumeration date
09/16/2006
Last updated
10/16/2023
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