Individual
JEFFREY G WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9280 W SUNSET RD STE 200, LAS VEGAS, NV 89148
(702) 844-4846
(702) 844-4847
Mailing address
PO BOX 98978, LAS VEGAS, NV 89193-8978
(702) 216-3346
(702) 671-6883
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
14017
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1568624187
—
NV
Enumeration date
06/25/2008
Last updated
11/30/2021
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