Provider Demographics
NPI:1821439928
Name:WAGGONER, JEFFREY M (CPED)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:M
Last Name:WAGGONER
Suffix:
Gender:M
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12120 LIV 302
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:MO
Mailing Address - Zip Code:64601-8210
Mailing Address - Country:US
Mailing Address - Phone:660-646-1517
Mailing Address - Fax:
Practice Address - Street 1:12120 LIV 302
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:MO
Practice Address - Zip Code:64601-8210
Practice Address - Country:US
Practice Address - Phone:660-646-1517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies