Individual
DR. BRENT WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7703 FLOYD CURL DR # MC7882, NEPHROLOGY/MEDICINE/UTHSCSA, SAN ANTONIO, TX 78229-3901
(210) 567-4700
(210) 567-4731
Mailing address
800 BRADBURY DR SE STE 116, ALBUQUERQUE, NM 87106-4310
(505) 272-1476
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
L2044
TX
207RN0300X
Nephrology Physician
L2044
TX
207RN0300X
Nephrology Physician
Primary
MD2018-0891
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
174006001
—
TX
Enumeration date
07/05/2006
Last updated
10/29/2024
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