Individual
PETER WILLIAM WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
30 W MCCREIGHT AVE, SUITE 208, SPRINGFIELD, OH 45504-1842
(937) 399-7021
(937) 399-0697
Mailing address
30 W MCCREIGHT AVE, SUITE 208, SPRINGFIELD, OH 45504-1842
(937) 399-7021
(937) 399-0697
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
OH35-04-2823
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0431590
—
OH
Enumeration date
08/03/2006
Last updated
07/08/2007
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