Organization
WAYNE L. WAGONER, DPM, PC
Active
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
Update your record
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