MEDICARE: JEFFREY JOSEPH WARGO MD

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
1	207N00000X	Dermatology Physician	35.140202	OH
2	207NS0135X	Procedural Dermatology Physician	01087514A	IN
3	207R00000X	Internal Medicine Physician	35.140202	OH
4	207ND0101X	MOHS-Micrographic Surgery Physician	01087514A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720217615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY JOSEPH WARGO MD

Provider Business Mailing Address
First Line	:	830 SIM HODGIN PKWY
Second Line	:
City	:	RICHMOND
State	:	IN
Zip	:	47374-1931
Country	:	US
Telephone Number	:	765-939-7664
Fax Number	:

Provider Business Practice Location Address
First Line	:	830 SIM HODGIN PKWY
Second Line	:
City	:	RICHMOND
State	:	IN
Zip	:	47374-1931
Country	:	US
Telephone Number	:	765-939-7664
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2009
Last Update Date	:	11/09/2023

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