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General NPI Number Information
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NPI Number | 1750219754
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Entity Type | Individual
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Provider Name | DANE WAGNER MD
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Gender | Male
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Dates
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Enumeration Date | 05/11/2026
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Last Update Date | 05/11/2026
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Provider Practice Location Address
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Address Line | OCHSNER CLINIC FOUNDATION - 1401 A. JEFFERSON HIGHWAY ACADEMIC CENTER, 1ST FLOOR
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City | NEW ORLEANS
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State | LA
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Zip | 70121
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Country | US
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Telephone | 504-842-3260
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Fax |
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Provider Business Mailing Address
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Address Line | 101 E ROMANA ST APT 492
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City | PENSACOLA
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State | FL
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Zip | 32502-5870
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Country | US
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Telephone | 850-855-6631
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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