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NPI Code Detail

MEDICARE: THOMAS E WAGGONER I D.O.

MEDICARE: THOMAS E WAGGONER I D.O.
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
1207RC0000XCardiovascular Disease PhysicianOS11212FL
2207RC0000XCardiovascular Disease Physician25MB09443300NJ
3207RI0011XInterventional Cardiology Physician006643AZ
4207RC0000XCardiovascular Disease Physician006643AZ

General Provider Information

NPI Number : 1891083812
Entity Type Code : Individual
Provider Name (Legal Business Name) : THOMAS E WAGGONER I D.O.
Provider Business Mailing Address
First Line : 3375 N CAMPBELL AVE
Second Line :
City : TUCSON
State : AZ
Zip : 85719-2306
Country : US
Telephone Number : 520-838-2148
Fax Number :
Provider Business Practice Location Address
First Line : 2404 E RIVER RD STE 100
Second Line :
City : TUCSON
State : AZ
Zip : 85718-6521
Country : US
Telephone Number : 520-838-2148
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2011
Last Update Date : 07/11/2016

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Directions to “ THOMAS E WAGGONER I D.O.” Practice Location

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