Individual
CHRISTINA RUTH WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1530 LONE OAK RD, PADUCAH, KY 42003-7901
(271) 444-2444
Mailing address
209 NW 11TH ST, FAIRFIELD, IL 62837-1218
(618) 842-4470
(618) 842-4470
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01073102A
IN
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
036107740
IL
208000000X
Pediatrics Physician
036107740
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036107740
—
IL
Enumeration date
10/25/2005
Last updated
02/03/2025
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