John Wagner, M.D.
Psychiatry & Neurology, Child & Adolescent Psychiatry in Shreveport, LA. Individual provider (NPI-1).
NPI number1033320577
StatusActive
Last updated in NPPESMay 22, 2019
Details
- NPI
- 1033320577
- Entity type
- Individual (NPI-1)
- Name
- John Wagner
- Credential
- M.D.
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- May 25, 2007
- Last updated
- May 22, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2084P0804X | Psychiatry & Neurology, Child & Adolescent Psychiatry | MD.201230 | LA | Yes |
Practice location
7330 Fern Ave Ste 704Shreveport, LA 71105-4985
Phone 318-798-8261 · Fax 316-798-8263
Mailing address
7330 Fern Ave Ste 704Shreveport, LA 71105-4985
Phone 318-798-8261 · Fax 316-798-8263
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