Wagner, Jeffrey David

Wagner, Jeffrey David is an individual health care provider with primary practice located at 8040 Clearvista Pkwy Ste 520 , Indianapolis IN 46256-5604. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Plastic and Reconstructive Surgery, Allopathic & Osteopathic Physicians / Plastic Surgery. Allopathic & Osteopathic Physicians / Plastic Surgery is his primary health care specialty. Wagner, Jeffrey David can be contacted via phone (317) 621-9470.

Contact Information

Primary practice address
8040 Clearvista Pkwy Ste 520 Indianapolis IN 46256-5604
Phone: (317) 621-9470
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Plastic and Reconstructive Surgery 2086S0122X 01041504 Indiana
Allopathic & Osteopathic Physicians / Plastic Surgery 208200000X 01041504A Indiana

Profile Details

NPI number 1881690790
LBN Legal business name Wagner, Jeffrey David
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 24th, 2005
Last updated Sep 1st, 2022 - about 4 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 1881690790 NPPES
Indiana MEDICAID 100347810

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