Individual
DAX ELI WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
815 HANKS ST, LUFKIN, TX 75904-4961
(936) 635-2840
Mailing address
815 HANKS ST, LUFKIN, TX 75904-4961
(936) 635-2840
Taxonomy
Speciality
Code
Description
License number
State
247100000X
Radiologic Technologist
Primary
GMR00096682
TX
2471C3401X
Computed Tomography Radiologic Technologist
GMR00096682
TX
2471C3402X
Radiography Radiologic Technologist
GMR00096682
TX
Other
Enumeration date
12/20/2018
Last updated
12/20/2018
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