Organization
WAGNER MEDICAL CLINIC L.L.P.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RALPH WAGNER MD (MD)
(361) 594-3824
Entity
Organization
Contact information
Practice address
124 E WOLTERS 2ND, SHINER, TX 77984-7109
(361) 594-3824
Mailing address
PO BOX 965, SHINER, TX 77984-0965
(361) 594-3824
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
063629201
—
TX
01
—
0T01U
BLUE CROSS
TX
Enumeration date
11/09/2005
Last updated
06/10/2010
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