Wagner, Ethan E

Wagner, Ethan E is an individual health care provider with primary practice located at 2015 Jackson St , Anderson IN 46016-4337. He recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medicine, which is considered as his primary health care specialty. Wagner, Ethan E can be contacted via phone (765) 646-8439.

Contact Information

Primary practice address
2015 Jackson St Anderson IN 46016-4337
Phone: (765) 646-8439
Fax: (765) 646-8578
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 02002898A Indiana

Profile Details

NPI number 1386643310
LBN Legal business name Wagner, Ethan E
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 20th, 2005
Last updated Oct 10th, 2007 - about 18 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 1386643310 NPPES
Indiana Other 000000514519 BLUE CROSS /ANTHEM

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