Waggoner, Kyle Marie

Waggoner, Kyle Marie is an individual health care provider with primary practice located at 13330 Usf Laurel Dr , Tampa FL 33612-6601. She recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery, which is considered as her primary health care specialty. Waggoner, Kyle Marie can be contacted via phone (813) 974-2201.

Contact Information

Primary practice address
13330 Usf Laurel Dr Tampa FL 33612-6601
Phone: (813) 974-2201
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery 213ES0103X PO3288 Florida

Profile Details

NPI number 1952573941
LBN Legal business name Waggoner, Kyle Marie
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 31st, 2008
Last updated May 8th, 2018 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1952573941 NPPES
Florida Other 6501B BLUE CROSS BLUE SHIELD
Florida MEDICAID 024263600 BLUE CROSS BLUE SHIELD

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