Individual
DR. JOHN A WAGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
800 N ALPHA ST, GRAND ISLAND, NE 68803-4320
(308) 382-2010
(308) 382-9549
Mailing address
800 N ALPHA ST, GRAND ISLAND, NE 68803-4320
(308) 382-2010
(308) 382-9549
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
14621
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
47071903800
—
NE
Enumeration date
05/27/2006
Last updated
02/15/2008
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