Individual
ELISABETH A WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
1250 8TH AVENUE, SUITE 435, FORT WORTH, TX 76104-4144
(817) 923-0088
(817) 924-5144
Mailing address
P. O. BOX 961205, FORT WORTH, TX 76161-1205
(817) 740-8400
(817) 924-5144
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
M8411
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
190303102
—
TX
05
—
190303103
—
TX
01
—
P00927384
RAILROAD MEDICARE
TX
Enumeration date
06/07/2006
Last updated
10/07/2011
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