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Dr. William Robert Wagner
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NPI Number Detailed Information
Provider Information:
| Name: | Dr. William Robert Wagner |
| Gender: | M |
| Provider License Number If Given: | R055430 |
NPI Information:
| NPI: | 1043219587 |
| Entity Type (Individual or Organization): |
1-ind |
| Enumeration Date: | 7/18/2005 |
| Last Update Date: | 4/29/2016 |
Provider Business Mailing Address:
| Address: | 1000 HEALTH CENTER ROAD KYLE HEALTH CENTER / DHHS/IHS Kyle, SD 57752 |
| Phone Number: | 9176269011 |
| Fax Number: |
Provider Business Practice Location Address:
| Address: | 1000 HEALTH CENTER ROAD KYLE HEALTH CENTER / DHHS/IHS Kyle, SD 57752 |
| Phone Number: | 9176269011 |
| Fax Number: |
Provider Taxonomy:
| Primary: | 1041C0700X |
| Secondary (if any): | 163W00000X |
| State: | SD |
