Individual
DR. KRISTOPHER M.G. WAGNER-PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
331 SIJAN AVE, WHITEMAN AFB, MO 65305-1269
(666) 687-2252
Mailing address
331 SIJAN AVE, WHITEMAN AFB, MO 65305-1269
(666) 687-2252
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
01065866A
IN
Other
Enumeration date
10/07/2008
Last updated
10/07/2008
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