# DAVID VAN WAGNER MD PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Wagner Ear, Nose & Throat
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194076349
- **Authorized official:** DAVID VAN WAGNER M.D. (PHYSICIAN)
- **Authorized official phone:** (712) 234-8787

## Contact information

- **Practice address:** 2730 PIERCE ST STE 204, SIOUX CITY, IA 51104-3764
- **Practice address phone:** (712) 234-8787
- **Practice address fax:** (712) 234-8777
- **Mailing address:** 1000 W 4TH ST STE 8, YANKTON, SD 57078-3700
- **Mailing address phone:** (605) 655-1414
- **Mailing address fax:** (605) 655-1420

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Y00000X | Otolaryngology Physician | — | NULL | Yes |
| 207Y00000X | Otolaryngology Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/27/2012
- **Last updated:** 11/05/2012