MEDICARE: DR. JOHN P WAGGONER MD, MPH

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	207X00000X	Orthopaedic Surgery Physician	A164955	CA
2	207XS0106X	Orthopaedic Hand Surgery Physician	A164955	CA

General Provider Information

NPI Number	:	1104320076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN P WAGGONER MD, MPH

Provider Business Mailing Address
First Line	:	34800 BOB WILSON DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92134-0001
Country	:	US
Telephone Number	:	619-532-5404
Fax Number	:

Provider Business Practice Location Address
First Line	:	34800 BOB WILSON DRIVE
Second Line	:	DEPT OF ORTHOPAEDIC SURGERY
City	:	SAN DIEGO
State	:	CA
Zip	:	92134-0001
Country	:	US
Telephone Number	:	619-532-5404
Fax Number	:

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

Provider Enumeration Date	:	03/23/2018
Last Update Date	:	01/30/2026

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