Individual
DONNA M WAGSTAFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4438 TELEGRAPH RD, SAINT LOUIS, MO 63129-3316
(314) 543-5996
(314) 543-5958
Mailing address
4438 TELEGRAPH RD, SAINT LOUIS, MO 63129-3316
(314) 543-5996
(314) 543-5958
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
120005
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
156880001
MEDICARE PTAN #
MO
Enumeration date
08/15/2005
Last updated
04/09/2019
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