Wayne L. Wagoner, DPM, PC

Primary specialty

Podiatric Clinic/CenterTaxonomy code 261QP1100X

License

00526 Issued in IA

Legal business name

WAYNE L. WAGONER, DPM, PC

Practice address

515 Rosemere LN
Maquoketa, IA 52060-2615

Phone

(563) 652-9777

Fax

(563) 652-9778

NPI assigned

Dec 4, 2012

Last updated

Dec 4, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Wayne Leroy Wagoner, DPMNPI 1508079138

Title

Owner

Phone

(563) 652-9777

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Wayne L Wagoner, DPM

  • Podiatrist
  • Maquoketa, IA
  • NPI 1508079138
  Authorized official Same address or phone

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

{
    "created_epoch": "1354579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354579200000",
    "number": "1568707446",
    "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": {
        "organization_name": "WAYNE L. WAGONER, DPM, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-04",
        "last_updated": "2012-12-04",
        "status": "A",
        "authorized_official_last_name": "WAGONER",
        "authorized_official_first_name": "WAYNE",
        "authorized_official_middle_name": "LEROY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "563-652-9777",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "261QP1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Podiatric",
            "state": "IA",
            "license": "00526",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1083683",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Matthew Lawrence Waack, D.C.
• Wayne L Wagoner, DPM
• Bradley B Waller, MD
• Roger R Waller, MD
• Walmart Inc. (Walmart Pharmacy 10-1509)
• Ashlyn Elizabeth Wernimont, LMSW
• Valerie Wersching
• Emily A Woods
• Sara Sue Wormley, PHARMD
• Bradley Jerome Young, DDS

• Podiatric Clinic/Center in Maquoketa, IA
• Providers in Maquoketa, IA by specialty
• Podiatric Clinic/Center in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2012; 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.