Wagner, John

Wagner, John is an sole proprietor health care provider with primary practice located at 7330 Fern Ave Ste 704 , Shreveport LA 71105-4985. He recently has only one registered license in Allopathic & Osteopathic Physicians / Child & Adolescent Psychiatry, which is considered as his primary health care specialty. Wagner, John can be contacted via phone (318) 798-8261.

Contact Information

Primary practice address
7330 Fern Ave Ste 704 Shreveport LA 71105-4985
Phone: (318) 798-8261
Fax: (316) 798-8263
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Child & Adolescent Psychiatry 2084P0804X MD.201230 Louisiana

Profile Details

NPI number 1033320577
LBN Legal business name Wagner, John
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date May 25th, 2007
Last updated May 22nd, 2019 - about 6 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.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1033320577 NPPES
Louisiana MEDICAID 1214841
Louisiana Other 4P278F600

Popular Providers