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General NPI Number Information
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NPI Number | 1821067935
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Entity Type | Individual
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Provider Name | THAO N. WAGNER M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/14/2006
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Last Update Date | 02/11/2022
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Provider Practice Location Address
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Address Line | NAVAL HOSPITAL PENSACOLA 6000 WEST HIGHWAY 98
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City | PENSACOLA
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State | FL
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Zip | 32512-0003
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Country | US
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Telephone | 850-505-6532
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Fax |
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Provider Business Mailing Address
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Address Line | NAVAL HOSPITAL PENSACOLA 6000 WEST HIGHWAY 98
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City | PENSACOLA
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State | FL
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Zip | 32512-0003
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Country | US
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Telephone | 850-505-6532
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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 | A123521
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | ME 105302
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License Number State | FL
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