Individual
GISELA L WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1223 GATEWAY DR, SUITE 1E, MELBOURNE, FL 32901-2607
(321) 312-3312
(321) 984-8483
Mailing address
3300 S FISKE BLVD, ROCKLEDGE, FL 32955-4306
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
ME98773
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
278670200
—
FL
01
—
94667
BCBS
FL
01
—
P01164130
RR MEDICARE
FL
Enumeration date
03/14/2006
Last updated
05/20/2022
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