Individual
MICHAEL D WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
81335
NM
207RP1001X
Pulmonary Disease Physician
Primary
81-335
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33308
—
NM
Enumeration date
07/07/2005
Last updated
04/11/2024
Update your record
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