Individual
RICHARD G. WAGGENER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3366 OAKDALE AVE N, ROBBINSDALE, MN 55422-2948
(763) 398-6383
Mailing address
2800 CAMPUS DR STE 10, PLYMOUTH, MN 55441-8812
(763) 559-2171
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
32784
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000062498
ANTHEM BLUE FACET
KY
05
—
01773615
—
NY
05
—
060794701
—
TX
05
—
1054560
—
KY
05
—
200114300
—
IN
05
—
2136905
—
OH
05
—
274540900A
—
GA
05
—
4817171
—
MI
05
—
64325491
—
KY
05
—
909773200
—
FL
05
—
XPY200541
—
CA
Enumeration date
05/10/2006
Last updated
11/10/2023
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