Provider Demographics
NPI:1942007653
Name:JOHN ALLEN VAN WAGONER, MD, PA
Entity type:Organization
Organization Name:JOHN ALLEN VAN WAGONER, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:VAN WAGONER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-398-3500
Mailing Address - Street 1:6100 WINDCOM CT STE 101
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-7887
Mailing Address - Country:US
Mailing Address - Phone:972-398-3500
Mailing Address - Fax:
Practice Address - Street 1:703 E FM 544 STE 160
Practice Address - Street 2:
Practice Address - City:MURPHY
Practice Address - State:TX
Practice Address - Zip Code:75094-4027
Practice Address - Country:US
Practice Address - Phone:214-764-2844
Practice Address - Fax:214-764-2298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty