Individual
DR. PHILIP L WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2301 HOUSE AVE, SUITE 400, CHEYENNE, WY 82001-3176
(307) 634-5216
(307) 638-6675
Mailing address
2301 HOUSE AVE, SUITE 400, CHEYENNE, WY 82001-3176
(307) 634-5216
(307) 638-6675
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
5171A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104211400
—
WY
Enumeration date
07/21/2006
Last updated
07/21/2010
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