Individual
DR. WILLIAM JORDAN WAGNER JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
601 E SAN ANTONIO ST, STE 501, VICTORIA, TX 77901-6004
(361) 575-6396
(361) 575-2728
Mailing address
601 E SAN ANTONIO ST, STE 501, VICTORIA, TX 77901-6004
(361) 575-6396
(361) 575-2728
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
D9704
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4341386
AETNA
TX
01
—
816535
BLUECROSS BLUESHIELD
TX
Enumeration date
06/22/2006
Last updated
07/08/2007
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