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CLINTON WAGGONER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
5151 N 9TH AVE, PENSACOLA, FL 32504-8721
(850) 476-8602
(850) 474-3518
Mailing address
PO BOX 9210, PENSACOLA, FL 32513-9210
(850) 476-8602
(850) 474-3518

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
26192
AL
2085R0202X
Diagnostic Radiology Physician
Primary
ME111431
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
007825700
FL
05
110982
AL
05
111222
AL
05
111224
AL
05
111236
AL
05
111237
AL
05
111238
AL
05
145235
AL
01
14P2L
BCBS OF FLORIDA
FL
01
51067334
BCBS
AL
01
51599265
BCBS
AL
01
51599266
BCBS
AL
01
51599267
BCBS
AL
01
51599269
BCBS
AL
01
51599270
BCBS
AL
01
51599271
BCBS
AL
01
592-19398
BCBS OF ALABAMA
FL
01
P01133899
RAILROAD MEDICARE
FL
Enumeration date
05/14/2007
Last updated
09/27/2023
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