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1366885501
BRENT WAGNER
PALM DESERT, CA
NPI
1366885501
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
207R00000X Internal Medicine
(Licence: CA 143208)
Enumeration Date
2013-04-08
Last Update Date
2020-04-16
Business Address
BRENT WAGNER M.D.
72605 HIGHWAY 111
PALM DESERT, CA 92260-3392
Phone number: 760-404-0135
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Mailing Address
BRENT WAGNER M.D.
72605 HIGHWAY 111
PALM DESERT, CA 92260-3392
Phone number: 760-404-0135
Copy
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