Individual
JOHN E WAGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1411 S CREASY LN, SUITE 120, LAFAYETTE, IN 47905-7433
(765) 447-4165
(765) 447-6978
Mailing address
PO BOX 4699, LAFAYETTE, IN 47903-4699
(765) 447-4165
(765) 447-6978
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
01020202A
IN
Other
Enumeration date
03/27/2006
Last updated
10/24/2007
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