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Individual

DR. COREY ALLEN WAGNER

Active
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Individual

DR. COREY ALLEN WAGNER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Taxonomy

Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
2010020901
MO
207V00000X
Obstetrics & Gynecology Physician
259975-1
NY
207VG0400X
Gynecology Physician
Primary
2010020901
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1144428038
MO
01
P01364351
RAILROAD MEDICARE
MO
Enumeration date
07/03/2007
Last updated
06/18/2021
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