Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0400X | Neurologist | 26744 | NE |
N | 2084N0400X | Neurologist | 6312366-1205 | UT |
Y | 2084N0600X | Clinical Neurophysiologist | 48115 | CO |
NPI | 1033321914 |
---|---|
Provider Name | Dr. Jeffrey C Wagner |
First Address | Englewood, CO 80113-3877 |
Second Address | Englewood, CO 80113-2780 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2007 |
Last Update Date | 01/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
COA105215 | MEMORIAL HOSPITAL UPIN (01) | CO |