| Doctor Name: | DONALD J WAGNER |
| NPI Number: | 1134248867 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.O. |
| License Number: | 3719 |
| Business Practice Address: | 1355 Ramar Rd Ste 11 Bullhead City, AZ - 864427100 |
| Business Phone Number: | 9287047202 |
| Business Fax Number: | 9287049207 |
| Mailing Address: | 1355 Ramar Rd, Ste 11 BULLHEAD CITY |
| State: | AZ |
| Postal Code: | 864427100 |
| Phone Number: | 9287047202 |
| Fax Number: | 9287049207 |
| NPI Enumeration Date: | 03/27/2007 |
| NPI Last Update Date: | 01/26/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207PE0004X |
| License Number: | 3719 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | AZ |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Emergency Medicine |
| Taxonomy Specialization: | Emergency Medical Services |
| Taxonomy Definition: | An emergency medicine physician who specializes in non-hospital based emergency medical services (e.g., disaster site, accident scene, transport vehicle, etc.) to provide pre-hospital assessment, treatment, and transport patients. |