Individual
GREGORY JOHN WAGMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OPA-C
Contact information
Practice address
4010 W 65TH ST, EDINA, MN 55435-1706
(952) 456-7000
(952) 456-7001
Mailing address
4200 DAHLBERG DR STE 300, GOLDEN VALLEY, MN 55422-4841
(952) 520-7870
(952) 520-7580
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
—
—
246ZX2200X
Orthopedic Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
HP34969
HEALTHPARTNER
—
Enumeration date
08/15/2006
Last updated
04/27/2018
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