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General NPI Number Information
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NPI Number | 1013640770
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Entity Type | Individual
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Provider Name | JONATHAN PAUL WAGER R.T. (R)(CT)(MR)(BD)
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Gender | Male
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Dates
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Enumeration Date | 07/08/2022
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Last Update Date | 07/08/2022
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Provider Practice Location Address
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Address Line | 700 19TH ST S
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City | BIRMINGHAM
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State | AL
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Zip | 35233-1927
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Country | US
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Telephone | 541-733-2411
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Fax |
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Provider Business Mailing Address
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Address Line | 1390 COUNTY RD. 411
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City | CLANTON
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State | AL
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Zip | 35045
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 576416
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License Number State | OR
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