DataLabs
datalabs.health made in the usa
DataLabs Facebook Wall   Like   Follow DataLabs on Twitter   Tweet  
Contact us Sign in |  Documentation | 
NPI Code Detail

MEDICARE: ELIJAH WAGONER

MEDICARE: ELIJAH WAGONER
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
1390200000XStudent in an Organized Health Care Education/Training ProgramOK

General Provider Information

NPI Number : 1699607515
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIJAH WAGONER
Provider Business Mailing Address
First Line : 14118 CEDAR CIR
Second Line :
City : OMAHA
State : NE
Zip : 68144-2120
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1111 W 17TH ST
Second Line :
City : TULSA
State : OK
Zip : 74107-1800
Country : US
Telephone Number : 402-690-6464
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2026
Last Update Date : 06/03/2026

Similar Medicare Providers

1215869441 — PEARSON GILES WEAVER
Practice Location Address:
1111 W 17TH ST
TULSA, OK
74107-1800
Practice Phone: 918-582-1972
Practice Fax:
1689506750 — BENJAMIN HOGAN
Practice Location Address:
1111 W 17TH ST
TULSA, OK
74107-1800
Practice Phone: 785-577-3303
Practice Fax:
1932031085 — AIDEN CARL BOYD
Practice Location Address:
1111 W 17TH ST
TULSA, OK
74107-1800
Practice Phone: 918-582-1972
Practice Fax:
1265364129 — JULIA ELISE CALLERY
Practice Location Address:
1111 W 17TH ST
TULSA, OK
74107-1800
Practice Phone: 918-582-1972
Practice Fax:
1417889338 — ALEXIS GILES
Practice Location Address:
1111 W 17TH ST
TULSA, OK
74107-1800
Practice Phone: 918-582-1972
Practice Fax:
1457284259 — TALN JAMES GLIDEWELL
Practice Location Address:
1111 W 17TH ST
TULSA, OK
74107-1800
Practice Phone: 918-582-1972
Practice Fax:

Directions to “ ELIJAH WAGONER ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.