Individual
MICHAEL WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
100 WOODS RD, VALHALLA, NY 10595-1530
(480) 818-3495
Mailing address
4316 E AVALON DR, #11, PHOENIX, AZ 85018-7245
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
009391
AZ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/28/2017
Last updated
05/27/2022
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