Wagner, Mark Andrew

Wagner, Mark Andrew is an sole proprietor health care provider with primary practice located at 36680 Cloverleaf Ave , Madera CA 93636-8519. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Wagner, Mark Andrew can be contacted via phone (209) 489-9347.

Contact Information

Primary practice address
36680 Cloverleaf Ave Madera CA 93636-8519
Phone: (209) 489-9347
Fax: (209) 720-0107
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X 20A5259 California

Profile Details

NPI number 1336130087
LBN Legal business name Wagner, Mark Andrew
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Nov 2nd, 2005
Last updated Jun 24th, 2024 - about 6 months 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 1336130087 NPPES
California Other 020A52590 BLUE SHIELD
California MEDICAID 00AX52590 BLUE SHIELD

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