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General NPI Number Information
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NPI Number | 1942007653
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Entity Type | Organization
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Legal Business Name | JOHN ALLEN VAN WAGONER, MD, PA
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Dates
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Enumeration Date | 02/28/2025
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Last Update Date | 02/28/2025
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Provider Practice Location Address
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Address Line | 703 E FM 544 STE 160
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City | MURPHY
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State | TX
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Zip | 75094-4027
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Country | US
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Telephone | 214-764-2844
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Fax | 214-764-2298
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Provider Business Mailing Address
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Address Line | 6100 WINDCOM CT STE 101
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City | PLANO
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State | TX
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Zip | 75093-7887
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Country | US
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Telephone | 972-398-3500
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN A VAN WAGONER
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Credential | MD
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Telephone | 972-398-3500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number |
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License Number State |
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