Individual
CARSON LEE WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1071 CALLA LILY CV, OVIEDO, FL 32766-0003
(407) 409-1616
Mailing address
1071 CALLA LILY CV, OVIEDO, FL 32766-0003
(407) 409-1616
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9112577
FL
Other
Enumeration date
08/27/2019
Last updated
10/20/2019
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