Individual
DR. WAYNE L WAGONER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
515 ROSEMERE LN, MAQUOKETA, IA 52060-2615
(563) 652-9777
(563) 652-9778
Mailing address
515 ROSEMERE LN, MAQUOKETA, IA 52060-2615
(563) 652-9777
(563) 652-9778
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
00526
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1083683
—
IA
Enumeration date
05/08/2007
Last updated
07/08/2007
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