Organization
WILLIAM W WAGNON M D P A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM WAGNON MD (OWNER)
(936) 632-6111
Entity
Organization
Contact information
Practice address
1421 S WHEELER ST, JASPER, TX 75951-5149
(936) 632-6111
Mailing address
1421 S WHEELER ST, JASPER, TX 75951-5149
(936) 632-6111
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
F2087
TX
Other
Enumeration date
04/09/2012
Last updated
06/22/2012
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