Individual
JONATHAN B WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2401 GILLHAM RD, KANSAS CITY, MO 64108-4619
(816) 234-3000
Mailing address
2401 GILLHAM RD, KANSAS CITY, MO 64108-4619
(816) 234-3000
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
2009003439
MO
2080P0202X
Pediatric Cardiology Physician
OT013523
PA
Other
Enumeration date
06/07/2010
Last updated
06/03/2013
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