MEDICARE: THANH H DUONG WAGNER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	22999	WI
2	207RC0000X	Cardiovascular Disease Physician	ME77423	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720088230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THANH H DUONG WAGNER MD

Provider Business Mailing Address
First Line	:	1411 N FLAGLER DR STE 8000
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-3413
Country	:	US
Telephone Number	:	561-655-1318
Fax Number	:	850-857-1747

Provider Business Practice Location Address
First Line	:	1411 N FLAGLER DR STE 8000
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-3413
Country	:	US
Telephone Number	:	561-655-1318
Fax Number	:	561-655-6623

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	09/14/2022

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Directions to “ THANH H DUONG WAGNER MD” Practice Location

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