Individual
STEPHEN IRWIN WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
401 OAKFIELD DR, BRANDON, FL 33511-5710
(813) 654-2273
(813) 654-1384
Mailing address
505 OAKFIELD DR, BRANDON, FL 33511-5700
(813) 654-2273
(813) 654-1384
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
ME15542
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
057050800
—
FL
Enumeration date
11/03/2005
Last updated
02/09/2016
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