Individual
DR. JESS BRUCE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1320 RIBAUT RD, PORT ROYAL, SC 29935-1118
(843) 986-0900
Mailing address
719 OKATIE HWY # 170, OKATIE, SC 29909-3963
(843) 987-7400
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
28789
SC
207R00000X
Internal Medicine Physician
Primary
ME125237
FL
Other
Enumeration date
09/26/2006
Last updated
10/02/2024
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