Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 34982 | MN |
N | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 34982 | MN |
NPI | 1255391058 |
---|---|
Provider Name | William E Wagner |
First Address | Minneapolis, MN 55440-0043 |
Second Address | Minneapolis, MN 55407-3723 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2006 |
Last Update Date | 10/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
019267800 | (05) | MN |
E69836 | (02) |