Russell Wagner
Orthopaedic Surgeon Adult Reconstructive Orthopaedic Surgeon
855 Montgomery St
Fort Worth
, Texas 76107-2553
Russell Wagner
Orthopaedic Surgeon Adult Reconstructive Orthopaedic Surgeon
855 Montgomery St
Fort Worth
, Texas 76107-2553
(817) 735-2902
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About
Features
Specialties
- Orthopaedic Surgeon
- Adult Reconstructive Orthopaedic Surgeon
Languages spoken
- English
Location
First Address
- Russell Wagner
- Po Box 99335
- Fort Worth, TX
- Zip : 76199-0335
- Fax : (817) 735-2902
- Phone : (817) 735-2900
Second Address
- Russell Wagner
- 855 Montgomery St
- Fort Worth, TX
- Zip : 76107-2553
- Fax : (817) 735-2902
- Phone : (817) 735-2900
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FAQs
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207X00000X | Orthopaedic Surgeon | H4772 | TX |
| N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | H4772 | TX |
National Provider Identifier
| NPI | 1154365013 |
|---|---|
| Provider Name | Russell Wagner |
| First Address | Fort Worth, TX 76199-0335 |
| Second Address | Fort Worth, TX 76107-2553 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 15/06/2006 |
| Last Update Date | 22/05/2013 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 123495705 | (05) | TX |
| 8U1280 | BCBS (01) | TX |
| F29592 | (02) | TX |
| P00249664 | RAILROAD MEDICARE PIN (01) | TX |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.