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1164601936
LORI B WAGNER
TAMPA, FL
NPI
1164601936
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
207Q00000X Family Medicine
(Licence: FL OS6338)
Enumeration Date
2007-10-30
Last Update Date
2010-10-18
Business Address
Dr. LORI B WAGNER D.O.
1502 E FOWLER AVE
TAMPA, FL 33612-5416
Phone number: 813-866-0950
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Mailing Address
Dr. LORI B WAGNER D.O.
3905 APPLETREE DR
VALRICO, FL 33594-4316
Phone number: 813-689-6051
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