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NPI Code Detail

MEDICARE: ADAM RICHARD WAGGONER DO

MEDICARE: ADAM RICHARD WAGGONER DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine PhysicianOP60840174WA

General Provider Information

NPI Number : 1538420351
Entity Type Code : Individual
Provider Name (Legal Business Name) : ADAM RICHARD WAGGONER DO
Provider Business Mailing Address
First Line : 1016 TACOMA AVE
Second Line :
City : SUNNYSIDE
State : WA
Zip : 98944-2263
Country : US
Telephone Number : 509-837-1500
Fax Number :
Provider Business Practice Location Address
First Line : 200 UNIVERSITY PKWY
Second Line :
City : YAKIMA
State : WA
Zip : 98901-9539
Country : US
Telephone Number : 509-452-5100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/07/2012
Last Update Date : 04/13/2022

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