Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | G52985 | CA |
NPI | 1013095900 |
---|---|
Provider Name | Michael V. Wagner |
First Address | Napa, CA 94558-4306 |
Second Address | Napa, CA 94558-2906 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 11/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G529850 | (05) | CA |
F14945 | (02) |