Organization
WAYNE L. WAGONER, DPM, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WAYNE LEROY WAGONER DPM (OWNER)
(563) 652-9777
Entity
Organization
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
261QP1100X
Podiatric Clinic/Center
Primary
00526
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1083683
—
IA
Enumeration date
12/04/2012
Last updated
12/04/2012
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