Organization
WAGNER MEDICAL CLINIC L.L.P.
Active
Organization
WAGNER MEDICAL CLINIC L.L.P.
Active
Other names
Moulton Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
RALPH WAGNER MD (MD)
(361) 594-3824
Entity
Organization
Contact information
Practice address
100 S PECAN, MOULTON, TX 77975-0238
(361) 594-3824
Mailing address
PO BOX 965, SHINER, TX 77984-0965
(361) 594-3824
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
363A00000X
Physician Assistant
PA11615
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
063662301
—
TX
Enumeration date
11/09/2005
Last updated
11/02/2017
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