Individual
DR. RANDI R WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
10240 PARK MEADOWS DR, LONE TREE, CO 80124-5425
(303) 338-4545
Mailing address
10350 E DAKOTA AVE, DENVER, CO 80247-1314
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
33098
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01330984
—
CO
01
—
029145
KAISER COMMERCIAL NUMBER
CO
Enumeration date
09/14/2005
Last updated
06/22/2021
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