{"npi":"1033320577","type":"NPI-1","status":"active","name":{"display":"John Wagner M.D.","other":[],"first":"JOHN","last":"WAGNER","credential":"M.D."},"specialty":{"primary_taxonomy":"2084P0804X","primary_taxonomy_description":"Child & Adolescent Psychiatry","slug":"child-adolescent-psychiatry","schema_org_specialty":"Psychiatric","all":[{"code":"2084P0804X","description":"Child & Adolescent Psychiatry","primary":true,"state":"LA","license":"MD.201230"}]},"addresses":[{"purpose":"LOCATION","street_1":"7330 FERN AVE STE 704","city":"SHREVEPORT","state":"LA","postal_code":"711054985","country_code":"US","phone":"3187988261","fax":"3167988263"},{"purpose":"MAILING","street_1":"7330 FERN AVE STE 704","city":"SHREVEPORT","state":"LA","postal_code":"711054985","country_code":"US","phone":"3187988261","fax":"3167988263"}],"license":{"state":"LA","number":"MD.201230"},"identifiers":[{"type_code":"05","label":"Medicaid","value":"1214841","state":"LA","issuer":null},{"type_code":"01","label":"Other","value":"4P278F600","state":"LA","issuer":"MEDICARE - PTAN"}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"I20100901000375","type_code":"14-26","type_desc":"PRACTITIONER - PSYCHIATRY","state":"LA","pac_id":"7719001452"}]},"enumeration_date":"2007-05-25","last_updated":"2019-05-22","_meta":{"source":"NPPES","snapshot_date":"2019-05-22","doc_url":"https://findmynpi.com/api"}}