Individual
GEORGE M WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 STATE AVE, FARIBAULT, MN 55021-6337
(507) 334-3921
(507) 332-5299
Mailing address
2925 CHICAGO AVE, MINNEAPOLIS, MN 55407-1321
(612) 262-5000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
34981
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
779502500
—
MN
Enumeration date
03/25/2006
Last updated
11/10/2020
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