Individual
EDWARD STEVEN WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4330 SHERIDAN ST, STE 101, HOLLYWOOD, FL 33021
(954) 962-9802
(954) 962-2233
Mailing address
4330 SHERIDAN ST, STE 101, HOLLYWOOD, FL 33021
(954) 962-9802
(954) 962-2233
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
ME68203
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
379684100
—
FL
Enumeration date
02/09/2006
Last updated
04/19/2011
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