Wagner, Timothy R.

Wagner, Timothy R. is an individual health care provider with primary practice located at 330 Mercy Street , Lake City SC 29560. He recently has only one registered license in Allopathic & Osteopathic Physicians / Orthopaedic Surgery, which is considered as his primary health care specialty. Wagner, Timothy R. can be contacted via phone (843) 374-6431.

Contact Information

Primary practice address
330 Mercy Street Lake City SC 29560
Phone: (843) 374-6431
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Orthopaedic Surgery 207X00000X 29577 Kentucky

Profile Details

NPI number 1306899539
LBN Legal business name Wagner, Timothy R.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 18th, 2006
Last updated Jan 28th, 2014 - about 10 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 1306899539 NPPES
Kentucky MEDICAID 64295777

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