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NPI Code Detail

MEDICARE: ALLAN J WAGMAN MD

MEDICARE: ALLAN J WAGMAN MD
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
12085R0202XDiagnostic Radiology PhysicianG27772CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1386626729
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALLAN J WAGMAN MD
Provider Business Mailing Address
First Line : 1516 COTNER AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90025-3303
Country : US
Telephone Number : 310-445-2951
Fax Number : 310-479-1459
Provider Business Practice Location Address
First Line : 1516 COTNER AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90025-3303
Country : US
Telephone Number : 310-445-2951
Fax Number : 310-479-1459
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/18/2005
Last Update Date : 01/31/2014

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