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1184927394
DANIEL LEWIS WAGONER
ST PETERSBURG, FL
NPI
1184927394
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
207R00000X Internal Medicine
(Licence: FL uo2539)
Enumeration Date
2010-12-09
Last Update Date
2010-12-09
Business Address
Dr. DANIEL LEWIS WAGONER D.O.
6000 49TH ST N
ST PETERSBURG, FL 33709-2114
Phone number: 727-521-4411
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Mailing Address
Dr. DANIEL LEWIS WAGONER D.O.
8572 SWEET MAGNOLIA PL
SEMINOLE, FL 33777-4600
Phone number:
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