Provider Demographics
NPI:1548374192
Name:MAGNER, JOHN M (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:MAGNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:100 N 8TH ST STE 120
Mailing Address - Street 2:
Mailing Address - City:EAST SAINT LOUIS
Mailing Address - State:IL
Mailing Address - Zip Code:62201-2989
Mailing Address - Country:US
Mailing Address - Phone:618-337-2597
Mailing Address - Fax:618-337-2930
Practice Address - Street 1:100 N 8TH ST STE 120
Practice Address - Street 2:
Practice Address - City:EAST SAINT LOUIS
Practice Address - State:IL
Practice Address - Zip Code:62201-2989
Practice Address - Country:US
Practice Address - Phone:618-337-2597
Practice Address - Fax:618-337-2930
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036096177207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036096177OtherMEDICAL LICENSE #
IL036096177OtherMEDICAL LICENSE #