Most Relevant Information
Provider Data
| NPI Number: | 1003312117 |
| Provider Name: | JEFFREY WAGNER |
| Entity Type: | Individual |
| Taxonomy Code: | 224Y00000X |
| Specialty: | Clinical Exercise Physiologist |
| License Number: |
Most Important Dates
| Enumeration Date: | 04/05/2018 |
| Last Updated: | 04/05/2018 |
Provider Practice Location
3525 E LOUISE DR
MERIDIAN
ID
836426302
Practice Location Phone/Fax
| Phone: | 2087067050 |
| Fax: |
Provider Mailing Location
3525 E LOUISE DR
MERIDIAN
ID
836426302
Provider Mailing Phone/Fax
| Phone: | 2087067050 |
| Fax: |