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NPI Code Detail

MEDICARE: DONNA RM WAGNER M.D.

MEDICARE: DONNA RM WAGNER M.D.
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
1207L00000XAnesthesiology PhysicianJ0338TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1742710179A011OTHERTXCHAMPUS
2MDJ0338TXOTHERTXWORKERS COMPENSATION
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1487743969
Entity Type Code : Individual
Provider Name (Legal Business Name) : DONNA RM WAGNER M.D.
Provider Business Mailing Address
First Line : 2701 HOSPITAL DR
Second Line :
City : VICTORIA
State : TX
Zip : 77901-5749
Country : US
Telephone Number : 361-573-9181
Fax Number :
Provider Business Practice Location Address
First Line : 2701 HOSPITAL DR
Second Line :
City : VICTORIA
State : TX
Zip : 77901-5749
Country : US
Telephone Number : 361-573-9181
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2006
Last Update Date : 10/08/2024

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