Individual
ALISON WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1023 LIPSCOMB ST STE 200, FORT WORTH, TX 76104-3102
(817) 915-4784
Mailing address
1023 LIPSCOMB ST STE 200, FORT WORTH, TX 76104-3102
(817) 915-4784
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
758058
TX
Other
Enumeration date
02/07/2023
Last updated
02/10/2023
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