Individual
DR. FELICIA A WAGMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
8340 LAKEWOOD RANCH BLVD STE 210, LAKEWOOD RANCH, FL 34202
(941) 782-2800
(941) 782-2513
Mailing address
367 S. GULPH RD, ATTN: IPM CREDENTIALING, KING OF PRUSSIA, PA 19406-3121
(941) 782-2800
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
L3174
TX
207V00000X
Obstetrics & Gynecology Physician
Primary
ME130060
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
202059124
TAX ID
TX
Enumeration date
06/30/2006
Last updated
06/17/2019
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