Individual
TROY D WAGNER
Active
Individual
TROY D WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
442
MT
363AS0400X
Surgical Physician Assistant
Primary
MED-PAC-LIC-442
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000900323
BCBS PIN
MT
05
—
4307970
—
MT
Enumeration date
05/28/2006
Last updated
12/14/2021
Update your record
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