Individual
DR. DAVID LEE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1481 W 10TH ST, DEPARTMENT 116A, INDIANAPOLIS, IN 46202-2803
(317) 554-0000
(317) 554-0056
Mailing address
1481 W 10TH ST, DEPARTMENT 116A, INDIANAPOLIS, IN 46202-2803
(317) 554-0000
(317) 554-0056
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
01031872
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200099570B
—
IN
Enumeration date
05/10/2006
Last updated
09/26/2012
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