Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Dr. Jackson Wagoner, MD

Individual provider Pain Medicine (Anesthesiology) Physician · NPI 1689137408

Dr. Jackson Wagoner, MD is an Anesthesiology in Casper, Wyoming. Graduated from Nebraska College of Medicine in 2019, 7 years ago. Practices with Summit Memorial Medical Group LLC, a 40-clinician group, works from 4 locations, accepts Medicare assignment and offers telehealth. Licensed in Arizona, Florida and Wyoming.

Years since qualifying
7
Trained at
Nebraska College of Medicine
Licensed in
AZ, FL, WY
In the registry since
2019
Specialties on file
4
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

See every abbreviation used in this directory →

Practice location Address checks out

1541 Diamond Dr
Casper, WY 82601-6247
Phone: (307) 439-1097
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (3)

  • 1501 N Campbell Ave Rm 4401, Tucson, AZ 85724-0001 — (520) 626-7721
  • 1600 Sw Archer Rd, Gainesville, FL 32610-1702 — (352) 273-8610
  • 2600 Sixth St Sw, Canton, OH 44710-1702 — (330) 452-9911

Specialties & licences

Pain Medicine (Anesthesiology) Physician (primary) Taxonomy 207LP2900X · Licence 19414A (WY)
Pain Medicine (Anesthesiology) Physician Taxonomy 207LP2900X · Licence ME169309 (FL)
Anesthesiology Physician Taxonomy 207L00000X · Licence 69349 (AZ)
Anesthesiology Physician Taxonomy 207L00000X · Licence ME169309 (FL)

Record details

NPI number1689137408
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedApril 9, 2019
Last updated in NPPESApril 8, 2026
Certification dateApril 8, 2026
Mailing addressPo Box 100254, Gainesville, FL 32610-0254

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyANESTHESIOLOGY
Medical schoolNEBRASKA COLLEGE OF MEDICINE
Graduated 2019 (7 years in practice)
Group practice Summit Memorial Medical Group Llc — 40 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations10 on file with Medicare

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