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General NPI Number Information
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NPI Number | 1447394309
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Entity Type | Organization
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Legal Business Name | WAGG, INC.
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 09/22/2016
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Provider Practice Location Address
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Address Line | 2036 KRAMERIA ST
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City | DENVER
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State | CO
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Zip | 80207-3929
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Country | US
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Telephone | 303-934-6970
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Fax | 813-931-9862
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Provider Business Mailing Address
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Address Line | 2036 KRAMERIA ST
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City | DENVER
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State | CO
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Zip | 80207-3929
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Country | US
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Telephone | 303-934-6970
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Fax | 813-931-9862
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Authorized Official
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Title or Position | PRESIDENT
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Name | GEORGE ANDREW WAGGONER
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Credential | CSFA
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Telephone | 303-934-6970
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | SA.0001218
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License Number State | CO
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