Individual
DR. PHILLIP L WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1140 LEXINGTON RD, GEORGETOWN, KY 40324-9330
(502) 868-1100
Mailing address
106 WINDRIDGE DR, NICHOLASVILLE, KY 40356-8029
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
25974
KY
Other
Enumeration date
06/23/2006
Last updated
07/08/2007
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