Physician Compare National (NPI:1679683346)

HEALTHCARE PROVIDER: HENRY R WAGNER JR. MD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1679683346
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6507836087
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20120326000063
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	WAGNER
	Individual professional last name
Provider First Name	HENRY
	Individual professional first name
Provider Middle Name	R
	Individual professional middle name
Provider Name Suffix Text	JR.
	The name suffix of the provider if the provider is an individual. The name suffix is a ''generation-related'' suffix, such as Jr., Sr., II, III, IV, or V.
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL SCHOOL AT DALLAS
	Individual professional's medical school
Graduation Year	1968
	Individual professional's medical school graduation year
Primary Specialty	UROLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	8 PROFESSIONAL PARK DR
	Group Practice or individual's line 1 address
City	WEBSTER
	Group Practice or individual's city
State	TX
	Group Practice or individual's state
Zip Code	775984127
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	670008
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	HOUSTON PHYSICIANS' HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	450617
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	CLEAR LAKE REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y