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Individual
JEFFREY M WAGNER
Active
Individual
JEFFREY M WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
16033
SC
207K00000X
Allergy & Immunology Physician
35781
NC
207K00000X
Allergy & Immunology Physician
Primary
MD16033
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1235321233
—
NC
05
—
160337
—
SC
01
—
2174958B
MEDICARE PTAN
NC
01
—
E593334292
MEDICARE PTAN
SC
Enumeration date
10/26/2005
Last updated
10/31/2023
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