Active NPI
John E Wagoner, MD
- Orthopaedic Surgery Physician
- Lafayette, IN
National Provider Identifier
1891755252
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopaedic Surgery Physician
- License
- 01020202A
- Practice address
- 1411 S Creasy LN
Suite 120
Lafayette, IN 47905-7433 - Phone
- (765) 447-4165
- Fax
- (765) 447-6978
- NPI assigned
- Mar 27, 2006
- Sex
- Male
- Sole proprietor
- No
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 | 01020202A | IN | Primary |
Addresses
Primary practice location
1411 S Creasy LN
Suite 120
Lafayette, IN 47905-7433
Mailing address
PO Box 4699
Lafayette, IN 47903-4699
Phone (765) 447-4165
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01020202A | IN | MD | Orthopaedic Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143417600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1193184000000",
"number": "1891755252",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 4699",
"city": "LAFAYETTE",
"state": "IN",
"postal_code": "479034699",
"telephone_number": "765-447-4165",
"fax_number": "765-447-6978"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1411 S CREASY LN",
"address_2": "SUITE 120",
"city": "LAFAYETTE",
"state": "IN",
"postal_code": "479057433",
"telephone_number": "765-447-4165",
"fax_number": "765-447-6978"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGONER",
"first_name": "JOHN",
"middle_name": "E",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-27",
"last_updated": "2007-10-24",
"status": "A"
},
"taxonomies": [
{
"code": "207X00000X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery",
"state": "IN",
"license": "01020202A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lafayette, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 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.