Organization
WILLIAM W WAGNON MD PA
Active
Parent organization
WILLIAM W. WAGNON MD PA
Organization subpart
Yes
Provider details
NPI number
Legal business name
WILLIAM W. WAGNON MD PA
Authorized official
DR. WILLIAM W WAGNON MD (OWNER)
(936) 632-6111
Entity
Organization
Contact information
Practice address
2801 S JOHN REDDITT DR, SUITE B, LUFKIN, TX 75904-5666
(936) 632-6111
(936) 632-9182
Mailing address
2801 S JOHN REDDITT DR, SUITE B, LUFKIN, TX 75904-5666
(936) 632-6111
(936) 632-9182
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
8596-TG
TX
207W00000X
Ophthalmology Physician
Primary
F2087
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
093898701
—
TX
01
—
1902895345
NPI TYPE I
TX
Enumeration date
04/17/2007
Last updated
03/17/2015
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