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Individual

ALAN S. WAGNER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
3849 N PERRYVILLE RD, ROCKFORD, IL 61114-8080
(815) 397-5554
(866) 914-7534
Mailing address
3849 N PERRYVILLE RD, ROCKFORD, IL 61114-8080
(815) 397-5554
(866) 914-7534

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
36-099687
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036099687
IL
Enumeration date
05/26/2006
Last updated
05/19/2011
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