Individual
DYLAN PAUL WAGNER
Active
Individual
DYLAN PAUL WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
00172
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05153323
—
MS
01
—
3528936
UNITED HEALTHCARE
MS
01
—
5874982
CIGNA
MS
01
—
9469937
AETNA
MS
Enumeration date
10/19/2012
Last updated
07/23/2020
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