Individual
DR. DANIEL JASON WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
13526 PESETA CT, CORPUS CHRISTI, TX 78418-6932
(361) 949-0354
(361) 985-5147
Mailing address
13526 PESETA CT, CORPUS CHRISTI, TX 78418-6932
(361) 949-0354
(361) 985-5147
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
L8997
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
175143001
—
TX
05
—
175143002
—
TX
Enumeration date
09/20/2006
Last updated
06/15/2009
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