Wagner, Mark Andrew
Wagner, Mark Andrew is an sole proprietor health care provider with primary practice located at 36680 Cloverleaf Ave , Madera CA 93636-8519. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Wagner, Mark Andrew can be contacted via phone (209) 489-9347.Contact Information
Primary practice address
36680 Cloverleaf Ave
Madera CA 93636-8519
Phone: (209) 489-9347
Fax: (209) 720-0107
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Diagnostic Radiology | 2085R0202X | 20A5259 | California |
Profile Details
| NPI number | 1336130087 |
|---|---|
| LBN Legal business name | Wagner, Mark Andrew |
| Credentials | Doctor of Osteopathy (DO) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Nov 2nd, 2005 |
| Last updated | Jun 24th, 2024 - about 2 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1336130087 | NPPES |
| California | Other | 020A52590 | BLUE SHIELD |
| California | MEDICAID | 00AX52590 | BLUE SHIELD |
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