Individual
KENT R WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
311 E SPRUCE ST, GARDEN CITY, KS 67846-5679
(620) 275-3700
Mailing address
311 E SPRUCE ST, GARDEN CITY, KS 67846-5679
(620) 275-3700
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1500742
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100399780A
—
KS
Enumeration date
09/08/2005
Last updated
04/25/2013
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