Individual
DR. BRIAN LEO WAGGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2555 BERKSHIRE PKWY STE A, CLIVE, IA 50325-4646
(515) 987-0051
(515) 987-0054
Mailing address
2555 BERKSHIRE PKWY STE A, CLIVE, IA 50325-4646
(515) 987-0051
(515) 987-0054
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
28129
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0071670
—
IA
01
—
03583
BCBS
IA
01
—
47500
BCBS
IA
Enumeration date
01/30/2006
Last updated
12/23/2016
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