Individual
JACOB TIMOTHY WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
Mailing address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
1303
WI
Other
Enumeration date
04/13/2020
Last updated
01/13/2023
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