Active NPI
Dax Eli Wagner
- Radiologic Technologist
- Lufkin, TX
National Provider Identifier
1205308707
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Radiologic Technologist
- License
- GMR00096682
- Practice address
- 815 Hanks St
Lufkin, TX 75904-4961 - Phone
- (936) 635-2840
- NPI assigned
- Dec 20, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Computed Tomography Radiologic Technologist | 2471C3401X | GMR00096682 | TX | |
| Radiography Radiologic Technologist | 2471C3402X | GMR00096682 | TX | |
| Radiologic Technologist | 247100000X | GMR00096682 | TX | Primary |
Addresses
Primary practice location
815 Hanks St
Lufkin, TX 75904-4961
Mailing address
815 Hanks St
Lufkin, TX 75904-4961
Phone (936) 635-2840
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| GMR00096682 | TX | MD | Computed Tomography Radiologic Technologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1545264000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1545264000000",
"number": "1205308707",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "815 HANKS ST",
"city": "LUFKIN",
"state": "TX",
"postal_code": "759044961",
"telephone_number": "936-635-2840"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "815 HANKS ST",
"city": "LUFKIN",
"state": "TX",
"postal_code": "759044961",
"telephone_number": "936-635-2840"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "DAX",
"middle_name": "ELI",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-12-20",
"last_updated": "2018-12-20",
"status": "A"
},
"taxonomies": [
{
"code": "2471C3401X",
"taxonomy_group": "",
"desc": "Radiologic Technologist, Computed Tomography",
"state": "TX",
"license": "GMR00096682",
"primary": false
},
{
"code": "2471C3402X",
"taxonomy_group": "",
"desc": "Radiologic Technologist, Radiography",
"state": "TX",
"license": "GMR00096682",
"primary": false
},
{
"code": "247100000X",
"taxonomy_group": "",
"desc": "Radiologic Technologist",
"state": "TX",
"license": "GMR00096682",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lufkin, TX
- Villuna Family Medicine & Wellness Clinic PLLC
- Vincent Emergency Group, LLC
- Lyndy Vines, D.C.
- Ashli Rae Vinson, CCC/SLP
- Vivek Mangla, MD PC
- Jackson D Wagnon, M.D.
- William Wright Wagnon
- Wal-Mart Stores Texas LLC (Walmart Pharmacy 10-0140)
- Wal-Mart Stores Texas, LLC (Walmart Vision Center 30-0140)
- Wal-Mart Stores Texas, LLC. (Walmart pharmacy 10-3164)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.