MEDICARE: STEPHEN WAGERS, D.P.M., A.P.C.

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	213E00000X	Podiatrist	E1749	CA

General Provider Information

NPI Number	:	1275652554
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPHEN WAGERS, D.P.M., A.P.C.

Provider Business Mailing Address
First Line	:	9360 TWIN MOUNTAIN CIR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92126-4827
Country	:	US
Telephone Number	:	858-653-4647
Fax Number	:	858-603-3625

Provider Business Practice Location Address
First Line	:	9360 TWIN MOUNTAIN CIR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92126-4827
Country	:	US
Telephone Number	:	858-653-4647
Fax Number	:	858-603-3625

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. STEPHEN CLARK WAGERS
Credential	:	D.P.M.
Telephone Number	:	858-653-4647

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	08/22/2020

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