# JOHN VAN WAGONER MD

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Southwest ALlergy & Asthma Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1952624157
- **Authorized official:** DR. JOHN A. VAN WAGONER MD (OWNER/PRESIDENT)
- **Authorized official phone:** (972) 398-3500

## Contact information

- **Practice address:** 5012 SOUTH US HIGHWAY 75, SUITE 150, DENISON, TX 75020
- **Practice address phone:** (972) 398-3500
- **Practice address fax:** (972) 398-3512
- **Mailing address:** 6101 WINDCOM COURT, SUITE 400, PLANO, TX 75093-7817
- **Mailing address phone:** (972) 398-3500
- **Mailing address fax:** (972) 398-3512

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207K00000X | Allergy & Immunology Physician | K8854 | TX | Yes |

## Other

- **Enumeration date:** 03/03/2010
- **Last updated:** 03/03/2010