Michael Justin Wagoner, M.D.

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

ME103487 Issued in FL

Practice address

5426 Beaumont Center Blvd Ste 350
Tampa, FL 33634-5235

Phone

(813) 286-0033

Fax

(813) 282-1806

NPI assigned

Oct 26, 2007

Last updated

Jun 22, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Pathology

Education

University of South Florida College of Medicine, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Womens Care Florida LLCGroup PAC ID 9234031444, 324 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Women's Care Florida LLC

  • Obstetrics & Gynecology Physician
  • Tampa, FL
  • NPI 1013902923
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1193356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687392000000",
    "number": "1316126337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 748817",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303748817",
            "telephone_number": "813-286-0333",
            "fax_number": "813-282-1806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5426 BEAUMONT CENTER BLVD STE 350",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336345235",
            "telephone_number": "813-286-0033",
            "fax_number": "813-282-1806"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10000 bay pines blvd",
            "address_purpose": "LOCATION",
            "city": "bay pines",
            "state": "FL",
            "postal_code": "33744",
            "country_code": "US",
            "telephone_number": "727-398-6661 x12672",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5002 W Lemon St",
            "address_purpose": "LOCATION",
            "city": "Tampa",
            "state": "FL",
            "postal_code": "33609",
            "country_code": "US",
            "telephone_number": "813-286-0033",
            "fax_number": "813-282-1806",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGONER",
        "first_name": "MICHAEL",
        "middle_name": "JUSTIN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-10-26",
        "last_updated": "2023-06-22",
        "certification_date": "2023-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "FL",
            "license": "TRN8871",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "FL",
            "license": "ME103487",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathleen Wagner, R.N., M.S.N.
• Kayley Pace Wagner, APRN
• Lori B Wagner, D.O.
• Melanie Beth Wagner, M.S.ED., BCBA
• Nicholas Brennan Wagner, MD
• Paula Marie Wagoner, ARNP
• Ryan Colt Wagoner, M.D.
• Waseem Zechariah Wagrees, MD
• Jahid Ahmad Wahabzai, PA-C, DO
• Deena Wadie Wahba, CGC

• Anatomic Pathology & Clinical Pathology Physician in Tampa, FL
• Providers in Tampa, FL by specialty
• Anatomic Pathology & Clinical Pathology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.