Doctor Name: | MR. JAMES WAGES |
NPI Number: | 1740619949 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | |
Business Practice Address: | 1060 Gaffney Rd Stop 7500 Fort Wainwright, AK - 997035007 |
Business Phone Number: | 9073532584 |
Business Fax Number: | |
Mailing Address: | 1060 Gaffney Rd Stop 7500, FORT WAINWRIGHT |
State: | AK |
Postal Code: | 997035007 |
Phone Number: | 9073532584 |
Fax Number: | |
NPI Enumeration Date: | 11/07/2013 |
NPI Last Update Date: | 11/07/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |