Individual
MR. PAUL BROOKS WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
C.C.P.
Contact information
Practice address
1836 HARBOR CV, MODESTO, CA 95355-1856
(209) 484-8516
(209) 576-3613
Mailing address
1836 HARBOR CV, MODESTO, CA 95355-1856
(209) 484-8516
(209) 576-3613
Taxonomy
Speciality
Code
Description
License number
State
246XC2903X
Vascular Specialist/Technologist Cardiovascular
Primary
890191-0970
MS
Other
Enumeration date
09/15/2006
Last updated
07/08/2007
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