MEDICARE: MR. PAUL BROOKS WAGNER C.C.P.

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	246XC2903X	Vascular Specialist/Technologist Cardiovascular	890191-0970	MS

General Provider Information

NPI Number	:	1518063916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PAUL BROOKS WAGNER C.C.P.

Provider Business Mailing Address
First Line	:	1836 HARBOR CV
Second Line	:
City	:	MODESTO
State	:	CA
Zip	:	95355-1856
Country	:	US
Telephone Number	:	209-484-8516
Fax Number	:	209-576-3613

Provider Business Practice Location Address
First Line	:	1836 HARBOR CV
Second Line	:
City	:	MODESTO
State	:	CA
Zip	:	95355-1856
Country	:	US
Telephone Number	:	209-484-8516
Fax Number	:	209-576-3613

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

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	07/08/2007

Similar Medicare Providers

1003844978 — THE GREENVILLE CLINIC
Practice Location Address:

1502 S COLORADO ST
GREENVILLE, MS
38703-7219

Practice Phone: 662-332-9872
Practice Fax: 662-332-9878

1730142993 — VINOD KUMAR M.D.
Practice Location Address:

5020 COMMERCE DR
BAKERSFIELD, CA
93309

Practice Phone: 661-324-4100
Practice Fax: 661-324-4600

1770513475 — MITCHELL DIAGNOSTIC
Practice Location Address:

2250 N KIMBALL ST STE 600
MITCHELL, SD
57301-5335

Practice Phone: 605-996-2031
Practice Fax: 605-996-4496

1356428569 — MOBILE HEART STATION INC
Practice Location Address:

196 TIMBERLANE ROAD
PICAYUNE, MS
39466

Practice Phone: 601-799-5169
Practice Fax: 601-799-3998

1477400273 — DIGNITYCARE HOME LLC
Practice Location Address:

3100 DOVEHOUSE LN
MODESTO, CA
95355-8691

Practice Phone: 209-551-0787
Practice Fax: 916-357-7266

1609456680 — DR. ROSA PEVERINI MD
Practice Location Address:

3425 COFFEE RD STE A2
MODESTO, CA
95355-1582

Practice Phone: 209-524-9401
Practice Fax:

Directions to “ MR. PAUL BROOKS WAGNER C.C.P.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.