Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 35.096738 | OH |
NPI | 1134372980 |
---|---|
Provider Name | Dr. Ryan Scott Wagner |
First Address | Bucyrus, OH 44820-1566 |
Second Address | Bucyrus, OH 44820-1566 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2008 |
Last Update Date | 08/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2263161 | (05) | OH |