Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | G6095 | TX |
NPI | 1033103569 |
---|---|
Provider Name | Dr. Anne P Wagner |
First Address | Victoria, TX 77901-6050 |
Second Address | Victoria, TX 77901-6050 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2005 |
Last Update Date | 03/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
033323902 | (05) | TX |
C23036 | (02) | TX |