| Doctor Name: | JACK WAGONER |
| NPI Number: | 1518979665 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 036-100314 |
| Business Practice Address: | 1850 Gateway Dr Sycamore, IL - 601783192 |
| Business Phone Number: | 8157588671 |
| Business Fax Number: | 8157585610 |
| Mailing Address: | 1850 Gateway Dr, SYCAMORE |
| State: | IL |
| Postal Code: | 601783192 |
| Phone Number: | 8157588671 |
| Fax Number: | 8157585610 |
| NPI Enumeration Date: | 08/13/2006 |
| NPI Last Update Date: | 06/11/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208600000X |
| License Number: | 036-100314 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Surgery |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. |