Individual
DR. KATHRYN A WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
414 NAVARRO ST, STE 1407, SAN ANTONIO, TX 78205-2516
(210) 277-6255
(210) 277-6256
Mailing address
PO BOX 911230, DALLAS, TX 75391-1230
(972) 997-8000
(972) 234-2987
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
J0875
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
089953601
—
TX
05
—
089953605
—
TX
01
—
P01547654
RAILROAD MEDICARE
TX
Enumeration date
02/14/2006
Last updated
01/29/2016
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