MEDICARE: HAROLD WAGNER DO PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QG0300X	Geriatric Medicine (Family Medicine) Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	DC9723	OTHER	TX	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255438701
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAROLD WAGNER DO PA

Provider Business Mailing Address
First Line	:	7441 MARVIN D LOVE FWY
Second Line	:	SUITE 300
City	:	DALLAS
State	:	TX
Zip	:	75237-3490
Country	:	US
Telephone Number	:	972-572-1998
Fax Number	:	942-572-4842

Provider Business Practice Location Address
First Line	:	7441 MARVIN D LOVE FWY
Second Line	:	SUITE 300
City	:	DALLAS
State	:	TX
Zip	:	75237-3490
Country	:	US
Telephone Number	:	972-572-1998
Fax Number	:	942-572-4842

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. HAROLD G WAGNER
Credential	:	D.O.
Telephone Number	:	214-434-4031

Provider Enumeration Date	:	09/19/2006
Last Update Date	:	03/10/2010

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Directions to “HAROLD WAGNER DO PA ” Practice Location

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