Individual
JAMES S WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1300 ANNE ST NW, BEMIDJI, MN 56601-5103
(218) 333-5000
(218) 333-5360
Mailing address
PO BOX 5074, SIOUX FALLS, SD 57117-5074
(218) 333-5000
(218) 333-5360
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
30763
MN
208600000X
Surgery Physician
5910
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
142077
UCARE #
ND
01
—
1700497
MEDICA #
ND
01
—
1700718
MEDICA #
ND
05
—
198200100
—
MN
01
—
28133WA
MNBS #
ND
01
—
676663
AMERICA'S PPO/ARAZ #
ND
01
—
DA9011015601
PREFERRED ONE #
ND
01
—
HP25793
HEALTHPARTNERS #
ND
01
—
ND200073
LHS #
ND
Enumeration date
07/10/2006
Last updated
06/07/2022
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