Individual
DR. JON ANTHONY WAGNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1368 DADRIAN PROFESSIONAL PARK, GODFREY, IL 62035-1685
(618) 433-9701
(618) 433-9706
Mailing address
1368 DADRIAN PROFESSIONAL PARK, GODFREY, IL 62035-1685
(618) 433-9701
(618) 433-9706
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036120316
IL
207Q00000X
Family Medicine Physician
036120316
IL
207Q00000X
Family Medicine Physician
2006033803
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036120316
—
IL
Enumeration date
08/05/2007
Last updated
05/14/2025
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