| NPI | 1740738053 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVEN MARC WAGNER Managing Director 915-215-4478 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207V00000X Obstetrics & Gynecology | |
| 207W00000X Ophthalmology | |
| 207X00000X Orthopaedic Surgery | |
| 208000000X Pediatrics | |
| 2084N0400X Psychiatry & Neurology, Neurology | |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| 2085R0202X Radiology, Diagnostic Radiology | |
| 208600000X Surgery | |
| Enumeration Date | 2016-09-15 |
| Last Update Date | 2017-05-31 |