Individual
DR. DEREK WAGGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
1400 NW 12TH AVE STE 4065, MIAMI, FL 33136-1003
(305) 243-6952
Mailing address
1400 NW 12TH AVE STE 4065, MIAMI, FL 33136-1003
(305) 243-6952
Taxonomy
Speciality
Code
Description
License number
State
247ZC0005X
Clinical Laboratory Director (Non-physician)
Primary
DI53685
FL
Other
Enumeration date
08/10/2022
Last updated
08/10/2022
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