Individual
BRUCE WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
1410 CANAL POINT RD, LONGWOOD, FL 32750-4562
(407) 832-2955
(407) 339-2955
Mailing address
1410 CANAL POINT RD, LONGWOOD, FL 32750-4562
(407) 832-2955
(407) 339-2955
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA9107368
FL
Other
Enumeration date
02/06/2014
Last updated
02/06/2014
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