DIANE BROWN WAGNER (NPI# 1336180900) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336180900 |
| Entity Type | Individual |
| Full Name | DIANE BROWN WAGNER |
| Credential | MD |
| Practice Address |
1453 E Bert Kouns Loop Radiology Shreveport LA 71105-6800 |
| Mailing Address |
Po Box 9600 Dept 09-038 Texarkana TX 75505-9600 |
| Practice Telephone | 3186815440 |
| Mailing Telephone | 9186220436 |
| Mailing Fax Number | 9186646120 |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2014-02-02 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
MD019017 | LA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| LA | 1990990 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104159615 | Diane Marie Wagner | Specialist | 364 Division St, Park Falls, WI 54552-1258 | 2009-09-15 |
| 1194812164 | Diane Wagner | Pathology | 43 Shebar Dr, Islip, NY 11751-4409 | 2006-10-09 |
| 1194211540 | Diane Wagner | Psychologist | 11130 Fairfax Blvd Ste 305, Fairfax, VA 22030-5035 | 2018-07-09 |
| 1366998528 | Diane Marie Wagner | Counselor | 4701 Van Dorn St, Lincoln, NE 68506-2562 | 2016-08-28 |
| 1235540402 | Diane Wagner | Pharmacist | 4963 John R Rd, Troy, MI 48085-3572 | 2014-05-09 |
| 1083777148 | Diane Wagner | Social Worker | 5100 2nd St Nw, Albuquerque, NM 87107-4009 | 2006-12-19 |
| 1770502338 | Diane Marie Wagner | Social Worker | 1601 Sw Archer Rd, Gainesville, FL 32608 | 2006-07-18 |
| Street Address |
1453 E BERT KOUNS LOOP RADIOLOGY |
| City | SHREVEPORT |
| State | LA |
| Zip Code | 71105-6800 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508863556 | Paula E Rembert | Obstetrics & Gynecology | 1453 E Bert Kouns Loop, Suite 221, Shreveport, LA 71105-6800 | 2005-07-06 |
| 1255754966 | Christus Highland Physician Group | Internal Medicine | 1453 E Bert Kouns Loop, Shreveport, LA 71105-6800 | 2014-01-31 |
| 1598925372 | Anuja Veluvolu | Internal Medicine | 1453 E Bert Kouns Loop, Shreveport, LA 71105-5634 | 2008-06-14 |
| 1144219031 | John D Bruchhaus | Internal Medicine | 1453 E Bert Kouns Loop, Shreveport, LA 71105-5634 | 2005-10-14 |
| 1629066568 | Christus Health Northern Louisiana | Internal Medicine | 1453 E Bert Kouns Loop, Shreveport, LA 71105-5634 | 2005-10-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699245928 | Misty Johnetta Ross | Counselor | 2942 Knight St., Bldg. 4 Suite 426, Shreveport, LA 71105 | 2018-11-29 |
| 1205301868 | Tatjhana Maury | Case Manager/Care Coordinator | 3325 Youree Drive, Shreveport, LA 71105 | 2018-10-10 |
| 1245710920 | Jefferey Douglas Adair Md | Non-Pharmacy Dispensing Site | 8860 Fern Ave., Suite 120, Shreveport, LA 71105 | 2018-08-21 |
| 1679059539 | Michael E Woolbert Dds LLC | Dentist | 7600 Fern Avenue, Building 1100, Shreveport, LA 71105 | 2018-07-13 |
| 1881195675 | Adiba Bibi | Pharmacist | 3555 Greenwood Road, Walgreens, Shreveport, LA 71105 | 2018-02-27 |
| 1740796655 | Allison Borel | Counselor | 2020 E 70th St Ste 201, Shreveport, LA 71105 | 2017-12-15 |
| 1073028148 | Valerie Wooten Barcelona | Physical Therapist | 130 Kayla Street, Shreveport, LA 71105 | 2017-12-11 |
| 1710497615 | Jimmy Carroll | Counselor | 2960 Knight St, Suite 110, Shreveport, LA 71105 | 2017-10-05 |
| 1932618444 | David Louis Bennett | Counselor | 3007 Knight St., Suite 200, Shreveport, LA 71105 | 2017-09-27 |
| 1619496452 | Shaqwana Hodge | Counselor | 2920 Knight St. Suite 110, Shreveport, LA 71105 | 2017-09-13 |
| Find all providers in zip 71105 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801393590 | Sterling Spine, LLC | Radiology | 708 N Ashley Ridge Loop Ste 400, Shreveport, LA 71106-7234 | 2018-04-09 |
| 1992046148 | Benjamin Vickers | Radiology | 8601 Rampart Pl, Shreveport, LA 71106-6227 | 2013-03-13 |
| 1053659672 | Lacy Holmes Williams | Radiology | 416 Travis St, Suite 1200, Shreveport, LA 71101-3282 | 2013-01-17 |
| 1710238100 | Thomas Archie Grant | Radiology | 9392 Stonebriar Cir, Shreveport, LA 71115-3728 | 2012-09-25 |
| 1174569412 | Ginger Auer-baker | Radiology | 708 N Ashley Ridge Loop, Suite #400, Shreveport, LA 71106-7234 | 2006-06-22 |
| 1932108578 | Open Mri of Northwest Louisiana LLC | Radiology | 855 Pierremont Rd, Suite 105, Shreveport, LA 71106-2084 | 2005-07-15 |
| 1548656465 | Evangeline Clinical Services, Inc. | Radiology | 855 Pierremont Rd, Suite 105, Shreveport, LA 71106-2084 | 2015-04-07 |
| 1619396702 | Aya Al Asfari | Radiology | 1541 Kings Hwy, Shreveport, LA 71103-4228 | 2014-04-16 |
| 1972947166 | Oluwayemisi M. Ojemakinde | Radiology | 1501 Kings Hwy, Internal Medicine, Shreveport, LA 71103-4228 | 2013-04-18 |
| 1750724555 | Virginia Ann Brown | Radiology | 1501 Kings Hwy, Dept. of Internal Medicine, Shreveport, LA 71103-4228 | 2013-04-10 |
| Find all providers in SHREVEPORT | ||||
| City | SHREVEPORT |
| Zip Code | 71105 |
Please comment or provide details below to improve the information on DIANE BROWN WAGNER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.