Individual
BRENT WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
72605 HIGHWAY 111, PALM DESERT, CA 92260-3392
(760) 404-0135
(760) 537-2948
Mailing address
72605 HIGHWAY 111, PALM DESERT, CA 92260-3392
(760) 404-0135
(760) 537-2948
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
143208
CA
Other
Enumeration date
04/08/2013
Last updated
04/16/2020
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