Individual
GRAHAM EDWARD WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
ONE MEDICAL CENTER DR., DHMC - DEPARTMENT OF PAIN MEDICINE, LEBANON, NH 03756-0001
(435) 901-4647
Mailing address
PO BOX 680464, PARK CITY, UT 84068-0464
(435) 901-4647
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
5918808-1205
UT
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
03/31/2014
Last updated
12/16/2021
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