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1235160102
GARY WAGNER
MODESTO, CA
NPI
1235160102
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
207N00000X Dermatology
(Licence: CA A24987)
Enumeration Date
2006-07-06
Last Update Date
2016-04-01
Business Address
-- GARY WAGNER M.D.
600 COFFEE RD
MODESTO, CA 95355-4201
Phone number: 209-524-1211
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Mailing Address
-- GARY WAGNER M.D.
600 COFFEE RD
MODESTO, CA 95355-4201
Phone number: 209-521-6097
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