Healthcare Provider Details

I. General information

NPI: 1861875007
Provider Name (Legal Business Name): JOSIAH WAGLER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2015
Last Update Date: 11/01/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 NW EXPRESSWAY STE 700
OKLAHOMA CITY OK
73112-4492
US

IV. Provider business mailing address

3001 QUAIL SPRINGS PKWY FL 5
OKLAHOMA CITY OK
73134-2640
US

V. Phone/Fax

Practice location:
  • Phone: 405-949-3816
  • Fax: 405-945-5173
Mailing address:
  • Phone: 405-949-3816
  • Fax: 405-945-5173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number7947
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: