Individual
MR. BRICE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
20 STARBRUSH CIR, COVINGTON, LA 70433-7208
(985) 231-5713
Mailing address
20 STARBRUSH CIR, COVINGTON, LA 70433-7208
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
05/25/2021
Last updated
05/25/2021
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