Individual
DR. JASON MICHAEL WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
940 NE 13TH ST, SUITE 4G4250, OKLAHOMA CITY, OK 73104-5008
(405) 271-5125
(405) 271-3462
Mailing address
940 NE 13TH ST, SUITE 4G4250, OKLAHOMA CITY, OK 73104-5008
(405) 271-5125
(405) 271-3462
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
24510
OK
Other
Enumeration date
11/03/2005
Last updated
04/24/2010
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