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Organization
PAUL D WAGNER M D INC
Active
Organization
PAUL D WAGNER M D INC
Active
Other names
San Diego Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
CONNIE JOHNSON (OFFICE MGR)
(619) 718-9444
Entity
Organization
Contact information
Practice address
4060 FOURTH AVE, SUITE 100, SAN DIEGO, CA 92103-2120
(619) 718-9444
(619) 718-9440
Mailing address
4060 FOURTH AVE, SUITE 100, SAN DIEGO, CA 92103-2120
(619) 718-9444
(619) 718-9440
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
G77188
CA
Other
Enumeration date
11/16/2006
Last updated
11/14/2022
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