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General NPI Number Information
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NPI Number | 1326338989
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Entity Type | Organization
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Legal Business Name | MITCHELL S WAGNER MD PLLC
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Dates
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Enumeration Date | 04/15/2011
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Last Update Date | 09/29/2011
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Provider Practice Location Address
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Address Line | 60 E RIO SALADO PKWY STE 505
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City | TEMPE
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State | AZ
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Zip | 85281-9128
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Country | US
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Telephone | 602-903-0443
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Fax | 480-777-1345
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Provider Business Mailing Address
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Address Line | 60 E RIO SALADO PKWY STE 505
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City | TEMPE
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State | AZ
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Zip | 85281-9128
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Country | US
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Telephone | 602-903-0443
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Fax | 480-777-1345
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MITCHELL S WAGNER
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Credential | M.D.
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Telephone | 602-903-0443
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 27272
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License Number State | AZ
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