Individual
DR. BRIAN S WAGGONER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
428 N WILLOW AVE, COOKEVILLE, TN 38501-2339
(931) 854-9988
(931) 854-9977
Mailing address
428 N WILLOW AVE, COOKEVILLE, TN 38501-2339
(931) 854-9988
(931) 854-9977
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD27530
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3812970
—
TN
01
—
4033875
BLUE CROSS BLUE SHIELD
TN
Enumeration date
07/26/2005
Last updated
07/14/2016
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