Individual
CODY L. WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
718 N LINCOLN ST, GREENSBURG, IN 47240-1348
(812) 662-0588
(812) 663-5932
Mailing address
718 N LINCOLN ST, GREENSBURG, IN 47240-1348
(812) 662-0588
(812) 663-5932
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01059456
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200123810A
—
IN
Enumeration date
06/04/2006
Last updated
09/09/2008
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