Individual
MARK DARREL WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1120 E 34TH ST, HIBBING, MN 55746-2909
(218) 362-7100
(218) 362-7131
Mailing address
1120 E 34TH ST, HIBBING, MN 55746-2909
(218) 362-7100
(218) 362-7131
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
30642
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
701083400
—
MN
Enumeration date
11/20/2006
Last updated
12/04/2020
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