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Individual

JULIAN RICHARD WAGGONER III

Active
Sole proprietor

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
404 W FOUNTAIN ST, ALBERT LEA, MN 56007-2437
(507) 373-2384
Mailing address
21301 INDIAN HILLS RD, ALBERT LEA, MN 56007-4222

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
37261
MN

Other

Enumeration date
01/16/2006
Last updated
07/08/2007
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