Provider Demographics
NPI:1093907107
Name:WAGGONER, JOSHUA D (MD)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:D
Last Name:WAGGONER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10101 N 92ND ST STE 101
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4553
Mailing Address - Country:US
Mailing Address - Phone:480-747-6532
Mailing Address - Fax:480-889-6865
Practice Address - Street 1:10101 N 92ND ST STE 101
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4553
Practice Address - Country:US
Practice Address - Phone:480-747-6532
Practice Address - Fax:480-889-6865
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ47969163WC3500X, 207R00000X, 207RC0000X, 207RI0011X
TXN3380207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No163WC3500XNursing Service ProvidersRegistered NurseCardiac Rehabilitation
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX206687003Medicaid
TX206687005Medicaid
AZ820654Medicaid
TX206687004Medicaid
TX206687002Medicaid
TX206687002Medicaid
AZ820654Medicaid
TX206687003Medicaid
TXTXB154854Medicare PIN
TXTXB139041Medicare PIN
TXTXB154855Medicare PIN