Organization
LAURA WAGNER INC
Active
Organization
LAURA WAGNER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAURA WAGNER M.D. (PRESIDENT)
(314) 434-1111
Entity
Organization
Contact information
Practice address
14377 WOODLAKE DR, SUITE 111, TOWN AND COUNTRY, MO 63017-5735
(314) 434-1111
(314) 434-1127
Mailing address
PO BOX 790379, SAINT LOUIS, MO 63179-0379
(314) 434-1111
(314) 434-1112
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000094839
PTAN
MO
Enumeration date
08/06/2009
Last updated
11/28/2012
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