Provider Demographics
NPI:1396718326
Name:MAGNUSSON, JUDY LEE (DO)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:LEE
Last Name:MAGNUSSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14024 QUAIL POINTE DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-1006
Mailing Address - Country:US
Mailing Address - Phone:405-419-8447
Mailing Address - Fax:405-419-7745
Practice Address - Street 1:10021 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-2927
Practice Address - Country:US
Practice Address - Phone:405-692-9300
Practice Address - Fax:405-691-0062
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2885207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKE70380Medicare UPIN
OK100113360AMedicaid
OKOK400904Medicare PIN