Wagner, Michael D
Wagner, Michael D is an sole proprietor health care provider with primary practice located at 1010 Spruce St 3Rd Fl Area 5 , Espanola NM 87532-2724. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Pulmonary Disease. Allopathic & Osteopathic Physicians / Pulmonary Disease is his primary health care specialty. Wagner, Michael D can be contacted via phone (505) 367-0340.Contact Information
Primary practice address
1010 Spruce St 3Rd Fl Area 5
Espanola NM 87532-2724
Phone: (505) 367-0340
Fax: (505) 747-2025
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 81335 | New Mexico |
| Allopathic & Osteopathic Physicians / Pulmonary Disease | 207RP1001X | 81-335 | New Mexico |
Profile Details
| NPI number | 1043217797 |
|---|---|
| LBN Legal business name | Wagner, Michael D |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jul 7th, 2005 |
| Last updated | Apr 11th, 2024 - about 7 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1043217797 | NPPES |
| New Mexico | MEDICAID | 33308 |
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