Active NPI
Wayne L Wagoner, DPM
- Podiatrist
- Maquoketa, IA
National Provider Identifier
1508079138
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Podiatrist
- License
- 00526
- Practice address
- 515 Rosemere LN
Maquoketa, IA 52060-2615 - Phone
- (563) 652-9777
- Fax
- (563) 652-9778
- NPI assigned
- May 8, 2007
- 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 |
|---|---|---|---|---|
| Podiatrist | 213E00000X | 00526 | IA | Primary |
Addresses
Primary practice location
515 Rosemere LN
Maquoketa, IA 52060-2615
Mailing address
515 Rosemere LN
Maquoketa, IA 52060-2615
Phone (563) 652-9777
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083683 | Medicaid | IA |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00526 | IA | MD | Audiologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178582400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1508079138",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "515 ROSEMERE LN",
"city": "MAQUOKETA",
"state": "IA",
"postal_code": "520602615",
"telephone_number": "563-652-9777",
"fax_number": "563-652-9778"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "515 ROSEMERE LN",
"city": "MAQUOKETA",
"state": "IA",
"postal_code": "520602615",
"telephone_number": "563-652-9777",
"fax_number": "563-652-9778"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGONER",
"first_name": "WAYNE",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "DPM",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "213E00000X",
"taxonomy_group": "",
"desc": "Podiatrist",
"state": "IA",
"license": "00526",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1083683",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Maquoketa, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.