Individual
JOHN E WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
516 DELAWARE ST SE, PWB FIFTH FLOOR, SUITE 5-100, CLINIC 5B, MINNEAPOLIS, MN 55455-0356
(612) 626-2663
Mailing address
420 DELAWARE ST SE, MMC 692,UNIVERSITY OF MINNESOTA PHYSICIANS, MINNEAPOLIS, MN 55455-0341
(612) 626-2663
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
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