Individual
DONNA RM WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2701 HOSPITAL DR, VICTORIA, TX 77901-5749
(361) 573-9181
Mailing address
2701 HOSPITAL DR, VICTORIA, TX 77901-5749
(361) 573-9181
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
J0338
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
123558203
—
TN
01
—
742710179A011
CHAMPUS
TX
01
—
MDJ0338TX
WORKERS COMPENSATION
TX
Enumeration date
10/12/2006
Last updated
10/08/2024
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