JOHN WAGNER M.D. NPI 1033320577

NPI Information

NPI: 1033320577
Provider Name: JOHN WAGNER, M.D.
Classification: Psychiatry & Neurology - 2084P0804X
Entity Type: Individual

Specialization: Child & Adolescent Psychiatry

PECOS Registration: Yes

Address:
7330 FERN AVE STE 704
SHREVEPORT, LA
ZIP 71105
Phone: (318) 798-8261
Get Directions

John Wagner, M.D. is a child and adolescent psychiatry psychiatry neurology in Shreveport, LA. The provider is child & Adolescent Psychiatry is a subspecialty of psychiatry with additional skills and training in the diagnosis and treatment of developmental, behavioral, emotional, and mental disorders of childhood and adolescence. John Wagner, M.D. NPI is 1033320577. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

7330 FERN AVE STE 704
SHREVEPORT, LA
ZIP 71105-985
Phone: (318) 798-8261
Fax: (316) 798-8263

The NPI 1033320577 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 5/25/2007 and was last updated on 5/22/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2084P0804X	Psychiatry & Neurology	Child & Adolescent Psychiatry	MD.201230	LOUISIANA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1214841	MEDICAID	LOUISIANA
2	4P278F600	OTHER	LOUISIANA	MEDICARE - PTAN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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