Healthcare Provider Details

I. General information

NPI: 1841275476
Provider Name (Legal Business Name): WILLIAM F WAGNER JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 05/04/2021
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 BROADWAY STE 440
SEATTLE WA
98122-5377
US

IV. Provider business mailing address

600 BROADWAY STE 440
SEATTLE WA
98122-5377
US

V. Phone/Fax

Practice location:
  • Phone: 206-292-6252
  • Fax: 206-292-7893
Mailing address:
  • Phone: 206-292-6252
  • Fax: 206-292-7893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberMD35358
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: