DOUGLAS LEE WAGONER MD
NPI 1225027162
Family Medicine in Glencoe, MN

Q: What is Douglas Wagoner's NPI number?

The NPI number for Douglas Wagoner is 1225027162. It was assigned to this individual provider in the NPPES registry on October 13, 2005.

Q: What is Douglas Wagoner's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Q: When was this NPI record last updated?

The NPPES record for Douglas Wagoner was last updated on November 25, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since October 13, 2005

1805 HENNEPIN AVE N, GLENCOE REGIONAL HEALTH SERVICES, GLENCOE, MN 55336(320) 864-3121(320) 864-7887 Get Directions Write a Review

NPPES record last updated: November 25, 2020. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Douglas Lee Wagoner Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DOUGLAS LEE WAGONER MD (NPI 1225027162) is an individual family medicine provider in Glencoe, Minnesota, licensed in Minnesota (27782) and active in the NPI registry since October 2005.

NPPES Registry Identity

NPI1225027162

Entity TypeIndividualMale

Primary Taxonomy207Q00000X

Provider Legal NameDOUGLAS LEE WAGONERCredential: MD

Location Address1805 HENNEPIN AVE N, GLENCOE REGIONAL HEALTH SERVICESGlencoe, MN 55336-1416

Mailing Address1805 Hennepin Ave NGlencoe, MN 55336-1416 · (320) 864-3121 · Fax (320) 864-7887

Phone(320) 864-3121

Fax(320) 864-7887

Sole ProprietorNo

Enumeration DateOctober 13, 2005

Last NPPES UpdateNovember 25, 2020

NPPES CertifiedNovember 25, 2020

✔ NPI 1225027162 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

License✔ Licensed in MN · 27782

Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

1805 HENNEPIN AVE N, Glencoe, MN 55336

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Other Identifiers 1

Medicaid024767000MN

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ON-SITE PODIATRY, INC

Podiatrist (Foot & Ankle Surgery)