Individual
KEITH WAGGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1824 MURDOCH AVE, PARKERSBURG, WV 26101-3230
(304) 424-4111
(330) 656-5901
Mailing address
5700 DARROW RD, SUITE 106, HUDSON, OH 44236-5021
(330) 656-5911
(330) 656-5901
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
18247
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000428862
BC/BS
WV
05
—
0046291000
—
WV
05
—
0168152
—
OH
01
—
1060095
WV DWC
WV
Enumeration date
12/22/2005
Last updated
06/12/2008
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