Organization
DRS WAGNER & WAGNER PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RALPH WAGNER MD (PARTNER)
(361) 594-3824
Entity
Organization
Contact information
Practice address
124 E WOLTERS 2ND, SHINER, TX 77984-7109
(361) 594-3824
(361) 594-4104
Mailing address
PO BOX 965, SHINER, TX 77984-0965
(361) 594-3824
(361) 594-4104
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
H4771
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00J16X
BLUE CROSS
TX
05
—
017726301
—
TX
05
—
083112501
—
TX
Enumeration date
03/21/2006
Last updated
07/18/2008
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