Wagner, John
Wagner, John is an sole proprietor health care provider with primary practice located at 7330 Fern Ave Ste 704 , Shreveport LA 71105-4985. He recently has only one registered license in Allopathic & Osteopathic Physicians / Child & Adolescent Psychiatry, which is considered as his primary health care specialty. Wagner, John can be contacted via phone (318) 798-8261.Contact Information
Primary practice address
7330 Fern Ave Ste 704
Shreveport LA 71105-4985
Phone: (318) 798-8261
Fax: (316) 798-8263
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Child & Adolescent Psychiatry | 2084P0804X | MD.201230 | Louisiana |
Profile Details
| NPI number | 1033320577 |
|---|---|
| LBN Legal business name | Wagner, John |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | May 25th, 2007 |
| Last updated | May 22nd, 2019 - about 7 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1033320577 | NPPES |
| Louisiana | MEDICAID | 1214841 | |
| Louisiana | Other | 4P278F600 |
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