Wagner, Russell
Wagner, Russell is an individual health care provider with primary practice located at 1500 S Main St , Fort Worth TX 76104-4917. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Adult Reconstructive Orthopaedic Surgery, Allopathic & Osteopathic Physicians / Orthopaedic Surgery. Allopathic & Osteopathic Physicians / Orthopaedic Surgery is his primary health care specialty. Wagner, Russell can be contacted via phone (817) 702-7144.Contact Information
Primary practice address
1500 S Main St
Fort Worth TX 76104-4917
Phone: (817) 702-7144
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Adult Reconstructive Orthopaedic Surgery | 207XS0114X | H4772 | Texas |
| Allopathic & Osteopathic Physicians / Orthopaedic Surgery | 207X00000X | H4772 | Texas |
Profile Details
| NPI number | 1154365013 |
|---|---|
| LBN Legal business name | Wagner, Russell |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 15th, 2006 |
| Last updated | Dec 18th, 2023 - about last year |
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 | 1154365013 | NPPES |
| Texas | Other | 8U1280 | BCBS |
| Texas | Other | P00249664 | BCBS |
| Texas | MEDICAID | 123495705 | BCBS |
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