Individual
COLTYN MICHAEL WAGNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2401 S 31ST ST, TEMPLE, TX 76508-0001
(254) 724-5815
Mailing address
2401 S 31ST ST, MS-11-AG062, TEMPLE, TX 76508
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
TX
Other
Enumeration date
03/20/2026
Last updated
03/20/2026
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