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Individual

MR. DAVID KENT WAGNER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CSA, OPA

Contact information

Practice address
1008 TAVERN ROAD, STE 102, MARTINSBURG, WV 25401-2864
(304) 263-5129
Mailing address
1008 TAVERN ROAD, STE 102, MARTINSBURG, WV 25401-2864
(304) 263-5129

Taxonomy

Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary

Other

Enumeration date
12/14/2006
Last updated
07/08/2007
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