Individual
MITCHELL WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
520 ROSE LN, WICKENBURG, AZ 85390-1447
(928) 684-4365
(928) 684-2434
Mailing address
520 ROSE LN, WICKENBURG, AZ 85390-1447
(928) 684-4365
(928) 684-2434
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
27272
AZ
207XX0801X
Orthopaedic Trauma Physician
Primary
27272
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
457920
—
AZ
01
—
7878067
AETNA
AZ
01
—
AZ0866130
BCBS
AZ
Enumeration date
10/17/2006
Last updated
02/03/2016
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