Individual
MICHAEL DEAN WAGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
200 HAWKINS DR, IOWA CITY, IA 52242-1009
(319) 356-2864
(319) 356-0363
Mailing address
200 HAWKINS DR, IOWA CITY, IA 52242-1009
(319) 356-2864
(319) 356-0363
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
33058
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03422
WELLMARK BCBS
IA
Enumeration date
05/22/2007
Last updated
11/27/2007
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