Charles L Wagnon MD PA

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

D4346 Issued in TX

Legal business name

CHARLES L WAGNON MD PA

Practice address

777 E Wheatland Rd
Suite 102
Duncanville, TX 75116

Phone

(972) 298-4981

Fax

(972) 298-4984

NPI assigned

May 10, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Charles Lee Wagnon, MD

Title

Owner

Phone

(972) 298-4981

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193011200000",
    "number": "1023067527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "777 E WHEATLAND RD",
            "address_2": "SUITE 102",
            "city": "DUNCANVILLE",
            "state": "TX",
            "postal_code": "75116",
            "telephone_number": "972-298-4981",
            "fax_number": "972-298-4984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 E WHEATLAND RD",
            "address_2": "SUITE 102",
            "city": "DUNCANVILLE",
            "state": "TX",
            "postal_code": "75116",
            "telephone_number": "972-298-4981",
            "fax_number": "972-298-4984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES L WAGNON MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-10",
        "last_updated": "2007-10-22",
        "status": "A",
        "authorized_official_last_name": "WAGNON",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "972-298-4981",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "TX",
            "license": "D4346",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Obstetrics & Gynecology Physician in Duncanville, TX
• Providers in Duncanville, TX by specialty
• Obstetrics & Gynecology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.