Wagner, Jeffrey David
Wagner, Jeffrey David is an individual health care provider with primary practice located at 8040 Clearvista Pkwy Ste 520 , Indianapolis IN 46256-5604. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Plastic and Reconstructive Surgery, Allopathic & Osteopathic Physicians / Plastic Surgery. Allopathic & Osteopathic Physicians / Plastic Surgery is his primary health care specialty. Wagner, Jeffrey David can be contacted via phone (317) 621-9470.Contact Information
Primary practice address
8040 Clearvista Pkwy Ste 520
Indianapolis IN 46256-5604
Phone: (317) 621-9470
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Plastic and Reconstructive Surgery | 2086S0122X | 01041504 | Indiana |
| Allopathic & Osteopathic Physicians / Plastic Surgery | 208200000X | 01041504A | Indiana |
Profile Details
| NPI number | 1881690790 |
|---|---|
| LBN Legal business name | Wagner, Jeffrey David |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 24th, 2005 |
| Last updated | Sep 1st, 2022 - about 3 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1881690790 | NPPES |
| Indiana | MEDICAID | 100347810 |
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