MEDICARE: DR. CURTIS B WAGNER DPM

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	213E00000X	Podiatrist	PO1734	FL

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

General Provider Information

NPI Number	:	1972615037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CURTIS B WAGNER DPM

Provider Business Mailing Address
First Line	:	661 EAST ALTAMONTE DRIVE
Second Line	:	SUITE 210 FOOT AND ANKLE ASSOCIATES OF FLORIDA
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701
Country	:	US
Telephone Number	:	407-339-7759
Fax Number	:	407-830-0024

Provider Business Practice Location Address
First Line	:	7350 SANDLAKE COMMONS BLVD
Second Line	:	SUITE 3329
City	:	ORLANDO
State	:	FL
Zip	:	32819-8040
Country	:	US
Telephone Number	:	407-345-5211
Fax Number	:	407-345-5220

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	03/11/2010

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