# MICHAEL D WAGNER

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1043217797
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 81335 | NM | — |
| 207RP1001X | Pulmonary Disease Physician | 81-335 | NM | Yes |

## Other

- **Enumeration date:** 07/07/2005
- **Last updated:** 04/11/2024