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Individual

MR. DURAND WAGNER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
13601 PRESTON RD, STE 1000W, DALLAS, TX 75240-4911
(972) 715-5007
(972) 715-5682
Mailing address
PO BOX 650426, DALLAS, TX 75265-0426
(972) 715-5000

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1203497
TN
163WM0705X
Medical-Surgical Registered Nurse
RN0000039771
TN
367500000X
Certified Registered Nurse Anesthetist
Primary
RN0000039771
TN

Other

Enumeration date
09/21/2006
Last updated
08/22/2011
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