Individual
DR. COREY ALLEN WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
621 S NEW BALLAS RD, SUITE 499-A, SAINT LOUIS, MO 63141-8232
(314) 251-7650
Mailing address
621 S NEW BALLAS RD, SUITE 499-A, SAINT LOUIS, MO 63141-8232
(314) 251-7650
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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