Organization
SURGERY SPECIALISTS OF MISSOURI LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VAN L WAGNER MD (MEMBER)
(314) 776-7112
Entity
Organization
Contact information
Practice address
10007 KENNERLY RD, SUITE A, SAINT LOUIS, MO 63128-2179
(314) 776-7112
(314) 776-7114
Mailing address
PO BOX 29255, SAINT LOUIS, MO 63126-0255
(314) 776-7112
(314) 776-7114
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
05/22/2008
Last updated
07/29/2013
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