Individual
CAROLYN WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
208 OAK DR S STE 400, LAKE JACKSON, TX 77566-5640
(979) 285-2900
Mailing address
6431 FANNIN ST, MSB 3.020B, HOUSTON, TX 77030-1501
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
Q3306
TX
Other
Enumeration date
08/02/2012
Last updated
07/22/2025
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