Individual
MITCHELL WAGNER
Active
Individual
MITCHELL WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
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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