# DAVID GORDON WAGNER

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

## Provider details

- **NPI number:** 1326046897
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 174400000X | Specialist | D0051588 | MD | — |
| 207W00000X | Ophthalmology Physician | 0101053417 | VA | — |
| 207W00000X | Ophthalmology Physician | D0051588 | MD | Yes |
| 207W00000X | Ophthalmology Physician | G64967 | CA | — |
| 207W00000X | Ophthalmology Physician | MD20367 | DC | — |

## Other

- **Enumeration date:** 07/08/2005
- **Last updated:** 10/13/2010