Individual
DR. NICOLAUS ALEXANDER WAGNER-BARTAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1400 CRESSLER ST, UNIVERSITY OF TEXAS MD ANDERSON CANCER CENTER, HOUSTON, TX 77030
(713) 404-6868
Mailing address
2415 SOUTH BLVD, HOUSTON, TX 77098-5109
(713) 927-5008
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
M6943
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
216633201
—
TX
Enumeration date
06/05/2007
Last updated
02/08/2011
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