Individual
DAVID GORDON WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
D0051588
MD
207W00000X
Ophthalmology Physician
0101053417
VA
207W00000X
Ophthalmology Physician
Primary
D0051588
MD
207W00000X
Ophthalmology Physician
G64967
CA
207W00000X
Ophthalmology Physician
MD20367
DC
Other
Enumeration date
07/08/2005
Last updated
10/13/2010
Update your record
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