Wagoner, Richard W
Wagoner, Richard W is an individual health care provider with primary practice located at 615 N Promenade St , Havana IL 62644-1243. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Wagoner, Richard W can be contacted via phone (309) 543-6600.Contact Information
Primary practice address
615 N Promenade St
Havana IL 62644-1243
Phone: (309) 543-6600
Fax: (309) 543-2089
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 036104579 | Illinois |
Profile Details
| NPI number | 1861458952 |
|---|---|
| LBN Legal business name | Wagoner, Richard W |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 26th, 2006 |
| Last updated | Jun 1st, 2012 - about 14 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 | 1861458952 | NPPES |
| Illinois | MEDICAID | 036104579 |
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