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General NPI Number Information
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NPI Number | 1750348314
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Entity Type | Individual
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Provider Name | DANIEL B. WAGNER D.O.
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Gender | Male
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Dates
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Enumeration Date | 04/27/2006
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Last Update Date | 08/29/2025
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Provider Practice Location Address
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Address Line | 2901 ACME BRICK PLZ
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City | FORT WORTH
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State | TX
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Zip | 76109-4124
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Country | US
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Telephone | 817-529-1900
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Fax | 817-529-1910
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Provider Business Mailing Address
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Address Line | 2901 ACME BRICK PLZ
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City | FORT WORTH
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State | TX
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Zip | 76109-4124
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Country | US
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Telephone | 817-529-1900
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Fax | 817-529-1910
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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 | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | M6450
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207XS0114X
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Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
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License Number | M6450
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License Number State | TX
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