Wagner, Gary

Wagner, Gary is an individual health care provider with primary practice located at 600 Coffee Rd , Modesto CA 95355-4201. He recently has only one registered license in Allopathic & Osteopathic Physicians / Dermatology, which is considered as his primary health care specialty. Wagner, Gary can be contacted via phone (209) 524-1211.

Contact Information

Primary practice address
600 Coffee Rd Modesto CA 95355-4201
Phone: (209) 524-1211
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Dermatology 207N00000X A24987 California

Profile Details

NPI number 1235160102
LBN Legal business name Wagner, Gary
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 6th, 2006
Last updated Apr 1st, 2016 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1235160102 NPPES
California MEDICAID 00A249871

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