Laura Wagner Inc

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

LAURA WAGNER INC

Practice address

14377 Woodlake Dr
Suite 111
Town and Country, MO 63017-5735

Phone

(314) 434-1111

Fax

(314) 434-1127

NPI assigned

Aug 6, 2009

Last updated

Nov 28, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Laura Wagner, M.D.NPI 1669445060

Title

President

Phone

(314) 434-1111

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Laura Wagner Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Laura Wagner, Inc

  • Specialist
  • Saint Peters, MO
  • NPI 1487801635
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Laura Ella Wagner, M.D.

  • Specialist
  • Chesterfield, MO
  • NPI 1669445060
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1249516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354060800000",
    "number": "1194956276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 790379",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631790379",
            "telephone_number": "314-434-1111",
            "fax_number": "314-434-1112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14377 WOODLAKE DR",
            "address_2": "SUITE 111",
            "city": "TOWN AND COUNTRY",
            "state": "MO",
            "postal_code": "630175735",
            "telephone_number": "314-434-1111",
            "fax_number": "314-434-1127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAURA WAGNER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-06",
        "last_updated": "2012-11-28",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "314-434-1111",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "000094839",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mary M Kratz, DDS
• Christopher T. Labonte, MD
• Isabelle Marie Laposha, OTD, OTR/L
• Abbey Lauer, OD
• Timothy Laughter, LPC
• LB Chiropractic, LLC
• Morgan Huff Light, PLPC
• Natania Lipp
• Lisa B Dibler OD LLC
• Daili Llavona

• Dermatology Physician in Town and Country, MO
• Providers in Town and Country, MO by specialty
• Dermatology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.