Individual provider · Type 1 NPI
Brian Keith Wagner, D.P.M.
Foot Surgery Podiatrist · Farmington, CT
NPI number
1093743502
Active
Practice location
11 South Rd Lowr LEVEL20
Farmington, CT 06032-2483
Fax (860) 606-8025
Mailing address
11 South Road, Lower Level 20
Farmington, CT 06032
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Podiatrist | 213E00000X | 000793 (CT) |
| Radiology Podiatrist | 213ER0200X | 000793 (CT) |
| Foot & Ankle Surgery Podiatrist | 213ES0103X | 000862 (CT) |
| Foot Surgery Podiatrist Primary | 213ES0131X | 000793 (CT) |
Foot Surgery Podiatrist: Definition to come...
Another provider at this address
About NPI 1093743502
Brian Keith Wagner, D.P.M.'s National Provider Identifier is 1093743502, issued on Jun 30, 2006. The primary taxonomy on file is Foot Surgery Podiatrist (213ES0131X), and the practice location is in Farmington, CT. The record was last updated on Aug 20, 2020.