Robert Gene Wagoner II, DMD MD

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

7298 Issued in KY

Practice address

801 N. Elm Street
Henderson, KY 42420-2705

Phone

(270) 212-0330

Fax

(270) 212-0332

NPI assigned

Nov 2, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in KY

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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

• Green River Oral Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Henderson, KY
  • NPI 1750638334

  Oral and Maxillofacial Surgery

  NPD (past) Authorized official
• Bluegrass Oral & Maxillofacial Surgery PSC

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Lexington, KY
  • NPI 1922115625

  Oral & Maxillofacial Surgery

  NPD (past)
• Geisinger Clinic

  • Diagnostic Radiology Physician
  • Danville, PA
  • NPI 1558313023

  Oral and Maxillofacial Surgery

  NPD (past)

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

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346716800000",
    "number": "1740368935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 N. ELM STREET",
            "city": "HENDERSON",
            "state": "KY",
            "postal_code": "424202705",
            "telephone_number": "270-212-0330",
            "fax_number": "270-212-0332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 N. ELM STREET",
            "city": "HENDERSON",
            "state": "KY",
            "postal_code": "424202705",
            "telephone_number": "270-212-0330",
            "fax_number": "270-212-0332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGONER",
        "first_name": "ROBERT",
        "middle_name": "GENE",
        "name_prefix": "Dr.",
        "name_suffix": "II",
        "credential": "DMD MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-02",
        "last_updated": "2012-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "KY",
            "license": "7298",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "KY",
            "license": "7298",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE CROSS BLUE SH",
            "identifier": "000000299338",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64063514",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "60002003",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Janice Faye Vazquez
• Jennifer Gibson Vick, MS, CCC-SLP
• Myrian Noella Vinan Vega, MD
• Son Vo, PHARMD
• Lori Vowels
• Wal-Mart Stores East LP
• Wal-Mart Stores East, LP
• Walgreen Co
• Walgreen Co
• Walgreen Co.

• All providers in Henderson, KY
• Oral & Maxillofacial Surgery (D.M.D.) in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2012; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.