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Individual
KURT B WAGNER
Active
Individual
KURT B WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME36930
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010053499
RAILROAD MEDICARE
—
05
—
066638600
—
FL
01
—
35186
BCBS
FL
Enumeration date
06/12/2006
Last updated
08/09/2013
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