MEDICARE: DR. DAVID V WAGNER 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
1	207Y00000X	Otolaryngology Physician	29266	IA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00365203	OTHER	IA	MEDICARE RAILROAD

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1799	OTHER		MIDLANDS CHOICE
5	28672	OTHER	IA	WELLMARK BCBS OF IOWA
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508836123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID V WAGNER MD

Provider Business Mailing Address
First Line	:	2730 PIERCE ST
Second Line	:	SUITE 204
City	:	SIOUX CITY
State	:	IA
Zip	:	51104-3796
Country	:	US
Telephone Number	:	712-234-8787
Fax Number	:	712-234-8777

Provider Business Practice Location Address
First Line	:	2730 PIERCE ST
Second Line	:	SUITE 204
City	:	SIOUX CITY
State	:	IA
Zip	:	51104-3796
Country	:	US
Telephone Number	:	712-234-8787
Fax Number	:	712-234-8777

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	04/28/2008

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Directions to “ DR. DAVID V WAGNER MD” Practice Location

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