John A Wagoner, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

14621 Issued in NE

Practice address

800 N Alpha St
Grand Island, NE 68803-4320

Phone

(308) 382-2010

Fax

(308) 382-9549

NPI assigned

May 27, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1148688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1203033600000",
    "number": "1114974284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 N ALPHA ST",
            "city": "GRAND ISLAND",
            "state": "NE",
            "postal_code": "688034320",
            "telephone_number": "308-382-2010",
            "fax_number": "308-382-9549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 N ALPHA ST",
            "city": "GRAND ISLAND",
            "state": "NE",
            "postal_code": "688034320",
            "telephone_number": "308-382-2010",
            "fax_number": "308-382-9549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGONER",
        "first_name": "JOHN",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-27",
        "last_updated": "2008-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NE",
            "license": "14621",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47071903800",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Patricia Elaine Waage
• Richard K Waggoner, P.A.-C
• Becky Wagner
• Gretchen Lee Wagner, LIMHP
• Wagoner Medical Group PC
• Shirley Wahlgren, RN
• Rhonda Kay Wahls, RN
• Ryan T Waind, D.C.
• Wal-Mart Stores, Inc.
• Wal-Mart Stores, Inc.

• Internal Medicine Physician in Grand Island, NE
• Providers in Grand Island, NE by specialty
• Internal Medicine Physician in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2008; 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.