Individual
MARK DAVID WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1000 DEXTER AVE N STE 320, SEATTLE, WA 98109-4878
(206) 620-0333
(206) 462-7520
Mailing address
1000 DEXTER AVE N STE 320, SEATTLE, WA 98109-4878
(206) 620-0333
(206) 462-7520
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
MD00022633
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
378219
LABOR AND INDUSTRY
WA
Enumeration date
06/09/2006
Last updated
05/07/2019
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