Individual
ELLIOTT JAY WAGNER
Active
Individual
ELLIOTT JAY WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
036120986
IL
2085R0202X
Diagnostic Radiology Physician
2009029480
MO
2085R0202X
Diagnostic Radiology Physician
238657-1
NY
2085R0202X
Diagnostic Radiology Physician
25MA08122100
NJ
2085R0202X
Diagnostic Radiology Physician
Primary
G49698
CA
2085R0202X
Diagnostic Radiology Physician
MD2008-0777
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G496980
BLUE SHIELD
CA
05
—
00G496980
—
CA
05
—
02917751
—
NY
Enumeration date
05/15/2006
Last updated
07/28/2026
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