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General NPI Number Information
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NPI Number | 1942291562
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Entity Type | Individual
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Provider Name | ALAN L WAGONER MD
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Gender | Male
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Dates
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Enumeration Date | 11/02/2005
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Last Update Date | 03/13/2013
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Provider Practice Location Address
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Address Line | 1309 S JACKSON ST
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City | FRANKFORT
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State | IN
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Zip | 46041-3314
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Country | US
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Telephone | 765-656-3401
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Fax | 765-656-3415
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Provider Business Mailing Address
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Address Line | 1309 S JACKSON ST
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City | FRANKFORT
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State | IN
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Zip | 46041-3314
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Country | US
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Telephone | 765-656-3401
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Fax | 765-656-3415
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 01033827A
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License Number State | IN
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