Individual
DUSTIN WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
5401 N PORTLAND AVE STE 600, OKLAHOMA CITY, OK 73112-2090
(405) 713-9940
(405) 713-9941
Mailing address
3001 QUAIL SPRINGS PKWY FL 5, OKLAHOMA CITY, OK 73134-2640
(405) 713-9940
(405) 713-9941
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
4800
OK
Other
Enumeration date
05/24/2022
Last updated
01/12/2023
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