Individual
MR. PHILLIP LEROY WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
975 SERENO DR, OCCUPATIONAL MEDICINE, VALLEJO, CA 94589-2441
(707) 651-2243
Mailing address
1220 ILLINOIS ST, VALLEJO, CA 94590-3910
(707) 246-5744
Taxonomy
Speciality
Code
Description
License number
State
2083X0100X
Occupational Medicine Physician
Primary
20060083
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
087585
—
AZ
Enumeration date
07/10/2006
Last updated
12/15/2021
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