Provider Demographics
NPI:1588981435
Name:WAGGONER, REX DWAYNE JR (MD)
Entity type:Individual
Prefix:DR
First Name:REX
Middle Name:DWAYNE
Last Name:WAGGONER
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1345 RXR PLZ
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11556-1301
Mailing Address - Country:US
Mailing Address - Phone:516-783-4600
Mailing Address - Fax:646-846-3283
Practice Address - Street 1:138 DELANCEY ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-3325
Practice Address - Country:US
Practice Address - Phone:212-609-2541
Practice Address - Fax:212-609-2542
Is Sole Proprietor?:No
Enumeration Date:2010-04-30
Last Update Date:2019-11-07
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Provider Licenses
StateLicense IDTaxonomies
NY272098207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine