Individual
DR. WILLIAM FREDERICK WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8300 CONSTITUTION AVE NE SUITE 1106, ALBUQUERQUE, NM 87110-7624
(505) 291-2770
(505) 291-2707
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
(855) 540-4722
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
40658
CO
207L00000X
Anesthesiology Physician
51715
CA
207L00000X
Anesthesiology Physician
G0247
TX
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
2002-0462
NM
207LP2900X
Pain Medicine (Anesthesiology) Physician
2003-00422
NC
207LP2900X
Pain Medicine (Anesthesiology) Physician
MD36735
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
94173028
—
NM
Enumeration date
07/11/2006
Last updated
05/31/2022
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