Individual
DR. JAIME STEPHAN WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1331 N ELM ST STE 200, GREENSBORO, NC 27401-6304
(336) 274-9617
(336) 482-2177
Mailing address
PO BOX 63112, CHARLOTTE, NC 28263-3112
(336) 274-9617
(336) 482-2177
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
162768
OR
2085R0202X
Diagnostic Radiology Physician
2012-00139
NC
2085R0204X
Vascular & Interventional Radiology Physician
Primary
2012-00139
NC
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
01/03/2008
Last updated
03/10/2023
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