MEDICARE: DR. JOHN ALLEN VANWAGONER M.D.

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	174400000X	Specialist	K8854	TX

General Provider Information

NPI Number	:	1053389502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN ALLEN VANWAGONER M.D.

Provider Business Mailing Address
First Line	:	6101 WINDCOM CT STE 400
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-7820
Country	:	US
Telephone Number	:	972-398-3500
Fax Number	:	972-398-3512

Provider Business Practice Location Address
First Line	:	6101 WINDCOM CT
Second Line	:	SUITE 400
City	:	PLANO
State	:	TX
Zip	:	75093-7817
Country	:	US
Telephone Number	:	972-398-3500
Fax Number	:	972-398-3512

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

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	04/15/2026

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