Individual
DR. JOHN H WAGNER III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., C.M.D.
Contact information
Practice address
401 ARNOLD ST NE, CULLMAN, AL 35055-1968
(256) 739-9593
(256) 739-2984
Mailing address
PO BOX 339, 401 ARNOLD STREET NE, CULLMAN, AL 35056-0339
(256) 739-9593
(256) 739-2984
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
8613
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000027867
—
AL
05
—
009935241
—
AL
01
—
010066311
METRA RAILROAD MEDICARE
AL
01
—
051551301
BC/BS OF ALABAMA
AL
01
—
51027867
BC/BS OF ALABAMA
AL
Enumeration date
01/19/2006
Last updated
11/02/2009
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