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Mark Andrew Wagner, DO
Diagnostic Radiology Physician in Madera, California
NPI 1336130087

Mark Andrew Wagner is a Diagnostic Radiology Physician based in Modesto, CA and is specialized in Diagnostic Radiology. Mark Andrew Wagner practices in Madera, CA and has the professional credentials of DO. The NPI Number for Mark Andrew Wagner is 1336130087 and holds a License No. 20A5259 (California).

The current practice location address for Mark Andrew Wagner is 36680 Cloverleaf Ave, Madera, CA and can be reached out via phone at 209-489-9347 and via fax at 209-720-0107.

Location: 36680 Cloverleaf Ave, Madera, CA, 95356-9262
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1336130087
Provider Name
Mark Andrew Wagner
Credential
DO
Provider Entity Type
Individual
Gender
Male
Address
36680 Cloverleaf Ave, Madera, CA, 95356-9262
Phone Number
209-489-9347
Fax Number
209-720-0107
Provider Enumeration Date
11/02/2005
Last Update Date
07/20/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
020A52590 01 CA BLUE SHIELD
00AX52590 05 CA
institution
Provider Business Practice Location Address Details
Address
36680 Cloverleaf Ave
City
Madera
State
California
Zip
93636-8519
Phone Number
209-489-9347
Fax Number
209-720-0107
person
Provider Business Mailing Address Details
Address
36680 Cloverleaf Ave
City
Madera
State
California
Zip
93636-8519
Phone Number
209-489-9347
Fax Number
209-720-0107
person
Provider's Taxonomy Details 1
Type
Allopathic & Osteopathic Physicians
Classification
Radiology
Speciality
Diagnostic Radiology
Taxonomy
2085R0202X
License No.
20A5259 (California)
Definition
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.
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