1326338989 NPI number — MITCHELL S WAGNER MD PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326338989 NPI number — MITCHELL S WAGNER MD PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MITCHELL S WAGNER MD PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326338989
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
60 E RIO SALADO PKWY
Provider Second Line Business Mailing Address:
STE 505
Provider Business Mailing Address City Name:
TEMPE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85281-9128
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-903-0443
Provider Business Mailing Address Fax Number:
480-777-1345

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
60 E RIO SALADO PKWY
Provider Second Line Business Practice Location Address:
STE 505
Provider Business Practice Location Address City Name:
TEMPE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85281-9128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-903-0443
Provider Business Practice Location Address Fax Number:
480-777-1345
Provider Enumeration Date:
04/15/2011

Additional Information

Authorized Official

Authorized Official Last Name:
WAGNER
Authorized Official First Name:
MITCHELL
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
602-903-0443

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  27272 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com