MEDICARE: WILLIAM WAGNER MD PC

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	2084N0400X	Neurology Physician	44925	AZ

General Provider Information

NPI Number	:	1891073573
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAM WAGNER MD PC

Provider Business Mailing Address
First Line	:	PO BOX 468
Second Line	:
City	:	HIGLEY
State	:	AZ
Zip	:	85236-0468
Country	:	US
Telephone Number	:	330-929-2580
Fax Number	:	480-361-7388

Provider Business Practice Location Address
First Line	:	4135 S POWER RD STE 120
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85212-3626
Country	:	US
Telephone Number	:	330-929-2580
Fax Number	:	480-361-7388

Authorized Official
Title or Position	:	OWNER
Name	:	WILLIAM J WAGNER
Credential	:	MD
Telephone Number	:	330-929-2580

Provider Enumeration Date	:	07/28/2011
Last Update Date	:	07/28/2011

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