Doctor Name: | JAMES S WAGENAAR |
NPI Number: | 1194768754 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DO |
License Number: | 34005359 |
Business Practice Address: | 90 Jackson Pike Gallipolis, OH - 456311560 |
Business Phone Number: | 7404465201 |
Business Fax Number: | 7404465761 |
Mailing Address: | 90 Jackson Pike, GALLIPOLIS |
State: | OH |
Postal Code: | 456311560 |
Phone Number: | 7404465201 |
Fax Number: | 7404465761 |
NPI Enumeration Date: | 06/13/2006 |
NPI Last Update Date: | 02/09/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 207PE0004X |
License Number: | 34005359 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Emergency Medicine |
Taxonomy Specialization: | Emergency Medical Services |
Taxonomy Definition: | An emergency medicine physician who specializes in non-hospital based emergency medical services (e.g., disaster site, accident scene, transport vehicle, etc.) to provide pre-hospital assessment, treatment, and transport patients. |