Active NPI
Jackson D Wagnon, M.D.
- Orthopaedic Surgery Physician
- Lufkin, TX
National Provider Identifier
1386684645
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopaedic Surgery Physician
- License
- G8486
- Practice address
- 208 Gaslight Blvd
Lufkin, TX 75904-3166 - Phone
- (936) 634-8800
- NPI assigned
- Jun 7, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopaedic Surgery Physician | 207X00000X | G8486 | TX | Primary |
Addresses
Primary practice location
208 Gaslight Blvd
Lufkin, TX 75904-3166
Mailing address
208 Gaslight Blvd
Lufkin, TX 75904-3166
Phone (936) 634-8800
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 144108101 | Medicaid | TX |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G8486 | TX | MD | Orthopaedic Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149638400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1314662400000",
"number": "1386684645",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "208 GASLIGHT BLVD",
"city": "LUFKIN",
"state": "TX",
"postal_code": "759043166",
"telephone_number": "936-634-8800"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "208 GASLIGHT BLVD",
"city": "LUFKIN",
"state": "TX",
"postal_code": "759043166",
"telephone_number": "936-634-8800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNON",
"first_name": "JACKSON",
"middle_name": "D",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-06-07",
"last_updated": "2011-08-30",
"status": "A"
},
"taxonomies": [
{
"code": "207X00000X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery",
"state": "TX",
"license": "G8486",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "144108101",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lufkin, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.