Individual
RICHARD WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2900 S LOOP 256, PALESTINE, TX 75801-6958
(903) 731-1144
Mailing address
904 DRANE PL, CORSICANA, TX 75110-2536
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
35C.001377
OH
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
J4594
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
096949512
—
TX
05
—
096949513
—
TX
Enumeration date
05/18/2006
Last updated
04/02/2024
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