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Individual

HAROLD G WAGNER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.O.

Contact information

Practice address
7441 MARVIN D LOVE FWY, STE 300, DALLAS, TX 75237-3490
(972) 572-1998
(972) 572-4842
Mailing address
7441 MARVIN D LOVE FWY, STE 300, DALLAS, TX 75237-3490
(972) 572-1998
(972) 572-4842

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
H6679
TX
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
H6679
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
008PH
BCBS PIN
TX
05
140123437
TX
01
P00207035
RAILROAD MEDICARE PIN
TX
Enumeration date
10/11/2006
Last updated
03/03/2010
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