Provider Demographics
NPI:1104320076
Name:WAGGONER, JOHN P (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:WAGGONER
Suffix:
Gender:M
Credentials:MD, MPH
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:34800 BOB WILSON DRIVE
Mailing Address - Street 2:DEPT OF ORTHOPAEDIC SURGERY
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92134-0001
Mailing Address - Country:US
Mailing Address - Phone:619-532-5404
Mailing Address - Fax:
Practice Address - Street 1:34800 BOB WILSON DRIVE
Practice Address - Street 2:DEPT OF ORTHOPAEDIC SURGERY
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-0001
Practice Address - Country:US
Practice Address - Phone:619-532-5404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-23
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA164955207XS0106X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery