Individual
DR. KYLE MARIE WAGGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
13330 USF LAUREL DR, TAMPA, FL 33612-6601
(813) 974-2201
Mailing address
PO BOX 917770, ORLANDO, FL 32891-0001
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
PO3288
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
024263600
—
FL
01
—
6501B
BLUE CROSS BLUE SHIELD
FL
Enumeration date
03/31/2008
Last updated
05/08/2018
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