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Individual
DR. JOHN H WAGNER III
Active
Individual
DR. JOHN H WAGNER III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., C.M.D.
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
8613
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000027867
—
AL
05
—
009935241
—
AL
01
—
010066311
METRA RAILROAD MEDICARE
AL
01
—
051551301
BC/BS OF ALABAMA
AL
01
—
51027867
BC/BS OF ALABAMA
AL
Enumeration date
01/19/2006
Last updated
11/02/2009
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