Individual
DR. JOHN C WAGONLANDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
054246
CO
207R00000X
Internal Medicine Physician
48544
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
025040
KAISER COMMERCIAL NUMBER
CO
05
—
617417500
—
MN
05
—
77685016
—
CO
Enumeration date
08/04/2006
Last updated
05/20/2021
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