Provider Demographics
NPI:1285899401
Name:WAGNER, AUSTIN J (DO)
Entity type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:J
Last Name:WAGNER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:2750 CLAY EDWARDS DR
Mailing Address - Street 2:SUITE 304
Mailing Address - City:NORTH KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-3237
Mailing Address - Country:US
Mailing Address - Phone:816-842-5555
Mailing Address - Fax:816-842-8888
Practice Address - Street 1:2750 CLAY EDWARDS DR
Practice Address - Street 2:SUITE 304
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3237
Practice Address - Country:US
Practice Address - Phone:816-842-5555
Practice Address - Fax:816-842-8888
Is Sole Proprietor?:No
Enumeration Date:2008-07-28
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOT013004208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery