Diane Brown Wagner, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

MD019017 Issued in LA

Practice address

1453 E Bert Kouns Loop
Radiology
Shreveport, LA 71105-6800

Phone

(318) 681-5440

NPI assigned

Jun 8, 2006

Last updated

Feb 2, 2014By the provider in NPPES

Sex

Female

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": "1149724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1391299200000",
    "number": "1336180900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9600",
            "address_2": "DEPT 09-038",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755059600",
            "telephone_number": "918-622-0436",
            "fax_number": "918-664-6120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1453 E BERT KOUNS LOOP",
            "address_2": "RADIOLOGY",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711056800",
            "telephone_number": "318-681-5440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "DIANE",
        "middle_name": "BROWN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-08",
        "last_updated": "2014-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "LA",
            "license": "MD019017",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1990990",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Latisha Wadley
• James Michael Wages Jr., M.D.
• Gabrielle Renee Waggoner
• Sharon Waggoner, MSW
• Catherine C Wagner, CRNA
• Elizabeth Hansen Wagner, PT, DPT
• John Wagner, M.D.
• Sarah Wagner
• Hillary Wagnon
• Lauren Wagnon, PLPC

• Diagnostic Radiology Physician in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Diagnostic Radiology Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2014; 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.