Individual
HALEY ELYSE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
505 N HIGHWAY 77, SUITE 200, WAXAHACHIE, TX 75165-1128
(972) 923-1686
(972) 923-9268
Mailing address
505 N HIGHWAY 77, SUITE 200, WAXAHACHIE, TX 75165-1128
(972) 923-1686
(972) 923-9268
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
M2185
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1773210-02
—
TX
05
—
177321003
—
TX
01
—
8BR069
BCBS
TX
01
—
8F5194
BCBS
TX
Enumeration date
06/15/2006
Last updated
07/09/2009
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