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Individual

JOHN E WAGNER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
34354
MN
2080P0207X
Pediatric Hematology & Oncology Physician
Primary
34354
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
090290
FAIRVIEW
MN
01
1009344
PREFERREDONE
MN
01
100981
UCARE
MN
05
10387
ND
05
1688300
WI
05
1896241
LA
05
1970657
IA
05
2086719201
KS
01
2T332WA
BLUE CROSS BLUE SHIELD
MN
01
3624608
MEDICA - CHOICE
MN
01
3674548
MEDICA - PRIMARY
MN
01
768393
ARAZ
MN
05
7777470
SD
05
837207100
MN
01
HP22006
HEALTHPARTNERS
MN
Enumeration date
09/20/2006
Last updated
10/29/2012
Update your record

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