Individual
DR. TRAVIS WAGNER GLENN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
85 MAUI LANI PKWY, WAILUKU, HI 96793-2416
(808) 244-5766
Mailing address
85 MAUI LANI PKWY, WAILUKU, HI 96793-2416
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD21270
HI
Other
Enumeration date
06/06/2017
Last updated
08/31/2021
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