Individual
DR. BRIAN KEITH WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
11 SOUTH RD LOWR LEVEL20, FARMINGTON, CT 06032-2483
(860) 470-5703
(860) 606-8025
Mailing address
11 SOUTH ROAD, LOWER LEVEL 20, FARMINGTON, CT 06032
(860) 470-5703
(860) 606-8025
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
000793
CT
213ER0200X
Radiology Podiatrist
000793
CT
213ES0103X
Foot & Ankle Surgery Podiatrist
000862
CT
213ES0131X
Foot Surgery Podiatrist
Primary
000793
CT
Other
Enumeration date
06/30/2006
Last updated
08/20/2020
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