Darrel Waggoner
Clinical Genetics (M.D.)
5841 S Maryland Ave Mc 0077 Room O-500
Chicago
, Illinois 60637-1447
Darrel Waggoner
Clinical Genetics (M.D.)
5841 S Maryland Ave Mc 0077 Room O-500
Chicago
, Illinois 60637-1447
(773) 834-0946
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About
Features
Specialties
- Clinical Genetics (M.D.)
Languages spoken
- English
Location
First Address
- Darrel Waggoner
- 180 Harvester Dr Suite 110
- Burr Ridge, IL
- Zip : 60527-5993
- Fax : (773) 834-0946
- Phone : (773) 834-1061
Second Address
- Darrel Waggoner
- 5841 S Maryland Ave Mc 0077 Room O-500
- Chicago, IL
- Zip : 60637-1447
- Fax : (773) 834-0556
- Phone : (773) 834-9110
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207SG0201X | Clinical Genetics (M.D.) | 036090276 | IL |
National Provider Identifier
| NPI | 1669595872 |
|---|---|
| Provider Name | Darrel Waggoner |
| First Address | Burr Ridge, IL 60527-5993 |
| Second Address | Chicago, IL 60637-1447 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 10/04/2007 |
| Last Update Date | 23/04/2014 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| G99332 | (02) | IL |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.