Wagner, Corey Allen

Wagner, Corey Allen is an individual health care provider with primary practice located at 621 S New Ballas Rd Suite 499-A, Saint Louis MO 63141-8232. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Obstetrics & Gynecology, Allopathic & Osteopathic Physicians / Gynecology. Allopathic & Osteopathic Physicians / Gynecology is his primary health care specialty. Wagner, Corey Allen can be contacted via phone (314) 251-7650.

Contact Information

Primary practice address
621 S New Ballas Rd Suite 499-A Saint Louis MO 63141-8232
Phone: (314) 251-7650
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X 259975-1 New York
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X 2010020901 Missouri
Allopathic & Osteopathic Physicians / Gynecology 207VG0400X 2010020901 Missouri

Profile Details

NPI number 1144428038
LBN Legal business name Wagner, Corey Allen
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 3rd, 2007
Last updated Jun 18th, 2021 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1144428038 NPPES
Missouri MEDICAID 1144428038
Missouri Other P01364351

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