Individual
DIANE BROWN WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1453 E BERT KOUNS LOOP, RADIOLOGY, SHREVEPORT, LA 71105-6800
(318) 681-5440
Mailing address
PO BOX 9600, DEPT 09-038, TEXARKANA, TX 75505-9600
(918) 622-0436
(918) 664-6120
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
MD019017
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1990990
—
LA
Enumeration date
06/08/2006
Last updated
02/02/2014
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