Provider Demographics
NPI:1699779066
Name:MAGNESEN, DAVID T (DPM)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:T
Last Name:MAGNESEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:676 S BLUFF ST
Mailing Address - Street 2:STE 205
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-3568
Mailing Address - Country:US
Mailing Address - Phone:435-628-5690
Mailing Address - Fax:435-628-5805
Practice Address - Street 1:676 S BLUFF ST STE 205
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3568
Practice Address - Country:US
Practice Address - Phone:435-628-5690
Practice Address - Fax:435-628-5805
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9910213E00000X
UT370449-0501213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002102792Medicaid
1316310001Medicare NSC
UTU78065Medicare UPIN