Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 37032 | CA |
NPI | 1053489740 |
---|---|
Provider Name | Dr. Reed Eugene Vanwagenen |
First Address | Fresno, CA 93720 |
Second Address | Fresno, CA 93720 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2006 |
Last Update Date | 08/07/2007 |