Individual
KURT ALAN VAN WAGENEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1201 7TH ST SE, DECATUR, AL 35601-3337
(256) 764-9697
Mailing address
PO BOX 757, FLORENCE, AL 35631-0757
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
MD.37306
AL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/07/2017
Last updated
02/14/2023
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