Wagoner, Ryan Colt
Wagoner, Ryan Colt is an individual health care provider with primary practice located at 3515 E Fletcher Ave Mdc 14, Tampa FL 33613-4702. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Forensic Psychiatry, Allopathic & Osteopathic Physicians / Psychiatry, Student, Health Care / Student in an Organized Health Care Education/Training Program. Allopathic & Osteopathic Physicians / Psychiatry is his primary health care specialty. Wagoner, Ryan Colt can be contacted via phone (813) 974-8900.Contact Information
Primary practice address
3515 E Fletcher Ave Mdc 14
Tampa FL 33613-4702
Phone: (813) 974-8900
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Forensic Psychiatry | 2084F0202X | A124075 | California |
| Allopathic & Osteopathic Physicians / Psychiatry | 2084P0800X | 71582 | Georgia |
| Student, Health Care / Student in an Organized Health Care Education/Training Program | 390200000X | MT194511 | Pennsylvania |
| Allopathic & Osteopathic Physicians / Psychiatry | 2084P0800X | ME119037 | Florida |
Profile Details
| NPI number | 1952531204 |
|---|---|
| LBN Legal business name | Wagoner, Ryan Colt |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 21st, 2009 |
| Last updated | Mar 31st, 2021 - about 3 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 | 1952531204 | NPPES |
| Florida | MEDICAID | 015294500 | |
| Florida | Other | 1510A |
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