Individual
MARK W WAGGENER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1575 BEAM AVE, MAPLEWOOD, MN 55109-1126
(651) 232-7348
(651) 232-6665
Mailing address
7866 9TH STREET CIR N, OAKDALE, MN 55128-5347
(651) 735-7946
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
46143
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
926495700
—
MN
Enumeration date
09/06/2006
Last updated
08/08/2011
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