Individual
DR. ANDREW WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
52 W UNDERWOOD ST, ORLANDO, FL 32806-1110
(321) 842-8475
Mailing address
52 W UNDERWOOD ST, ORLANDO, FL 32806-1110
(321) 842-8475
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
266705
MA
2085R0204X
Vascular & Interventional Radiology Physician
2020015515
MO
2085R0204X
Vascular & Interventional Radiology Physician
Primary
ME149963
FL
208600000X
Surgery Physician
125067171
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110602800
—
FL
01
—
EKE7E
BCBS
FL
01
—
N3348
MEDICARE PTAN OHRI
FL
01
—
PS630
MEDICARE PTAN OHMG
FL
Enumeration date
06/08/2015
Last updated
03/28/2023
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