| Organization Name: | WAGNER MEDICAL CLINIC L.L.P. |
| NPI Number: | 1356322127 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RALPH WAGNER (MD) |
| Mailing Address: | 100 S Pecan Moulton |
| State: | TX US |
| Postal Code: | 779750238 |
| Phone Number: | 3615943824 |
| Fax Number: | |
| NPI Enumeration Date: | 11/09/2005 |
| NPI Last Update Date: | 07/07/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR1300X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rural Health |
| Taxonomy Definition: | |