Doctor Name: | DR. JOHN H WAGNER |
NPI Number: | 1487634085 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D., C.M.D. |
License Number: | 8613 |
Business Practice Address: | 401 Arnold St Ne Cullman, AL - 350551968 |
Business Phone Number: | 2567399593 |
Business Fax Number: | 2567392984 |
Mailing Address: | Po Box 339, 401 Arnold Street Ne CULLMAN |
State: | AL |
Postal Code: | 350560339 |
Phone Number: | 2567399593 |
Fax Number: | 2567392984 |
NPI Enumeration Date: | 01/19/2006 |
NPI Last Update Date: | 11/02/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 8613 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |