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Individual
DR. ANDREW WAGNER
Active
Individual
DR. ANDREW WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
266705
MA
2085R0204X
Vascular & Interventional Radiology Physician
2020015515
MO
2085R0204X
Vascular & Interventional Radiology Physician
Primary
ME149963
FL
208600000X
Surgery Physician
125067171
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110602800
—
FL
01
—
EKE7E
BCBS
FL
01
—
N3348
MEDICARE PTAN OHRI
FL
01
—
PS630
MEDICARE PTAN OHMG
FL
Enumeration date
06/08/2015
Last updated
03/28/2023
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