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Individual
DR. JACKSON WAGONER
Active
Individual
DR. JACKSON WAGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
69349
AZ
207L00000X
Anesthesiology Physician
ME169309
FL
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
19414A
WY
207LP2900X
Pain Medicine (Anesthesiology) Physician
ME169309
FL
Other
Enumeration date
04/09/2019
Last updated
04/08/2026
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