Most Relevant Information
Provider Data
| NPI Number: | 1003836248 |
| Provider Name: | WILLIS H. WAGNER M.D. |
| Entity Type: | Individual |
| Taxonomy Code: | 2086S0129X |
| Specialty: | Surgery |
| License Number: | G049464 |
Most Important Dates
| Enumeration Date: | 07/20/2006 |
| Last Updated: | 10/08/2007 |
Provider Practice Location
8631 W 3RD ST
SUITE 615E
LOS ANGELES
CA
900485901
Practice Location Phone/Fax
| Phone: | 3106528132 |
| Fax: | 3106593815 |
Provider Mailing Location
8631 W 3RD ST
SUITE 615E
LOS ANGELES
CA
900485901
Provider Mailing Phone/Fax
| Phone: | 3106528132 |
| Fax: | 3106593815 |