DERRICK D WAGONER, DO, Diagnostic Radiology EDMOND, OK

Contact Information

DERRICK D WAGONER, DO

1800 RENAISSANCE BLVD STE 110
EDMOND, OK 73013

Phone: 405-601-2325
Fax:
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Diagnostic Radiology	2085R0202X	30	Physician/Diagnostic Radiology

Indicates primary specialty

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NPI Profile & details for DERRICK D WAGONER · (Male)

NPI Number	`1760829220`
Status	Active
Credentials	DO (Doctor of Osteopathic)
Entity	Individual
Enumeration date	05/23/2013
Last updated	08/29/2025 - About 9 months ago
Sole proprietor ¹	Yes
Identifiers	OK License # 6324 OK Medicaid 200769850A
Hospital affiliation(s)	ARNOT OGDEN MEDICAL CENTER - (Acute Care) 600 ROE AVENUE ELMIRA, NY 14905 ARNOT OGDEN MEDICAL CENTER - (Acute Care) 600 ROE AVENUE ELMIRA, NY 14905 IRA DAVENPORT MEMORIAL HOSPITAL INC - (Acute Care) 7571 STATE ROUTE 54 BATH, NY 14810 IRA DAVENPORT MEMORIAL HOSPITAL INC - (Acute Care) 7571 STATE ROUTE 54 BATH, NY 14810 JONES MEMORIAL HOSPITAL - (Acute Care) 191 NORTH MAIN STREET WELLSVILLE, NY 14895 JONES MEMORIAL HOSPITAL - (Acute Care) 191 NORTH MAIN STREET WELLSVILLE, NY 14895 SENTARA VIRGINIA BEACH GENERAL HOSPITAL - (Acute Care) 1060 FIRST COLONIAL ROAD VIRGINIA BEACH, VA 23454 SENTARA VIRGINIA BEACH GENERAL HOSPITAL - (Acute Care) 1060 FIRST COLONIAL ROAD VIRGINIA BEACH, VA 23454

¹ A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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