Individual
DR. DAVID WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
91 GREGORY LN, SUITE 15, PLEASANT HILL, CA 94523-4981
(925) 685-0843
(925) 685-1899
Mailing address
DEPT 34929, P.O. BOX 39000, SAN FRANCISCO, CA 94139-0001
(925) 952-2828
(925) 952-2850
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
G55652
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G556520
—
CA
Enumeration date
07/17/2006
Last updated
06/21/2012
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