Individual
DR. TIMOTHY R. WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
330 MERCY STREET, LAKE CITY, SC 29560
(843) 374-6431
Mailing address
330 MERCY ST, LAKE CITY, SC 29560-2332
(843) 374-6431
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
29577
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64295777
—
KY
Enumeration date
05/18/2006
Last updated
01/28/2014
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