Individual
DR. GWENDOLYN FIELD WAGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
110 CHARLOIS BLVD, WINSTON SALEM, NC 27103-1522
(336) 768-3361
Mailing address
110 CHARLOIS BLVD, WINSTON SALEM, NC 27103-1522
(336) 768-3361
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
2007-00840
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2007-00840
NC STATE MEDICAL LICENSE
NC
Enumeration date
05/23/2007
Last updated
05/31/2019
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