Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 47969 | AZ |
N | 111NI0900X | Internist | 47969 | AZ |
N | 207R00000X | Internist | N3380 | TX |
N | 111NI0900X | Internist | N3380 | TX |
N | 207RC0000X | Internist - Cardiovascular Disease | 47969 | AZ |
Y | 207RI0011X | Interventional Cardiology | 47969 | AZ |
NPI | 1093907107 |
---|---|
Provider Name | Joshua D. Waggoner |
First Address | Scottsdale, AZ 85258-4553 |
Second Address | Scottsdale, AZ 85258-4553 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2007 |
Last Update Date | 21/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
206687002 | (05) | TX |
206687003 | (05) | TX |
206687004 | (05) | TX |
206687005 | (05) | TX |
820654 | (05) | AZ |