Wagoner, John A
Wagoner, John A is an individual health care provider with primary practice located at 800 N Alpha St , Grand Island NE 68803-4320. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Wagoner, John A can be contacted via phone (308) 382-2010.Contact Information
Primary practice address
800 N Alpha St
Grand Island NE 68803-4320
Phone: (308) 382-2010
Fax: (308) 382-9549
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 14621 | Nebraska |
Profile Details
| NPI number | 1114974284 |
|---|---|
| LBN Legal business name | Wagoner, John A |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 27th, 2006 |
| Last updated | Feb 15th, 2008 - about 17 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1114974284 | NPPES |
| Nebraska | MEDICAID | 47071903800 |
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