Individual
DR. JACKSON D WAGNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
208 GASLIGHT BLVD, LUFKIN, TX 75904-3166
(936) 634-8800
Mailing address
208 GASLIGHT BLVD, LUFKIN, TX 75904-3166
(936) 634-8800
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
G8486
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
144108101
—
TX
Enumeration date
06/07/2006
Last updated
08/30/2011
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