Individual
THEODORE A WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
UWMC-ROOSEVELT, 4245 ROOSEVELT WAY NE, SEATTLE, WA 98105-4740
(206) 598-4288
Mailing address
PO BOX 50095, SEATTLE, WA 98145-5095
(206) 543-6420
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
MD00011315
WA
207XP3100X
Pediatric Orthopaedic Surgery Physician
MD00011315
WA
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
MD00011315
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0232121
L&I
WA
05
—
1811077894
—
WA
01
—
9054
INTERNAL ID-MOTOR VEHICLE ID
—
Enumeration date
10/16/2006
Last updated
09/28/2011
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