Individual
DR. WAYNE A FAGAN
Active
Individual
DR. WAYNE A FAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
J4105
TX
207ND0900X
Dermatopathology Physician
45D0913782
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0040EE
BLUE CROSS BLUE SHIELD
TX
01
—
070017610
MEDICARE RAILROAD
TX
05
—
080856001
—
TX
01
—
1356536494
GROUP NPI #
TX
01
—
86470Y
BLUE CROSS
TX
01
—
CK7292
MEDICARE RAILROAD
TX
Enumeration date
06/22/2005
Last updated
05/16/2017
Update your record
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