Provider Demographics
NPI:1760004105
Name:MAGNESS, DAVID MATTHEW (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MATTHEW
Last Name:MAGNESS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:235 W PALM ST STE 105
Mailing Address - Street 2:
Mailing Address - City:BELLVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77418-1300
Mailing Address - Country:US
Mailing Address - Phone:832-443-9668
Mailing Address - Fax:
Practice Address - Street 1:235 W PALM ST STE 104
Practice Address - Street 2:
Practice Address - City:BELLVILLE
Practice Address - State:TX
Practice Address - Zip Code:77418-1300
Practice Address - Country:US
Practice Address - Phone:979-865-3124
Practice Address - Fax:979-865-9193
Is Sole Proprietor?:No
Enumeration Date:2020-05-07
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXT6632207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT6632OtherSTATE LICENSE