Provider Demographics
NPI:1689821506
Name:WAGGONER NOSS, ALEXIS C (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:C
Last Name:WAGGONER NOSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3740 W SYLVANIA AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4461
Mailing Address - Country:US
Mailing Address - Phone:419-473-6622
Mailing Address - Fax:
Practice Address - Street 1:3740 W SYLVANIA AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4461
Practice Address - Country:US
Practice Address - Phone:419-473-6622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35.099501207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH102310Medicare PIN