DUSTIN WAGNER PA NPI 1093453565

NPI Information

NPI: 1093453565
Provider Name: DUSTIN WAGNER, PA
Classification: Physician Assistant - 363AS0400X
Entity Type: Individual

Specialization: Surgical

PECOS Registration: Yes

Address:
5401 N PORTLAND AVE STE 600
OKLAHOMA CITY, OK
ZIP 73112
Phone: (405) 713-9940
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Dustin Wagner, PA is a surgical physician assistant in Oklahoma City, OK with 2 years of experience. Dustin Wagner, PA NPI is 1093453565. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

5401 N PORTLAND AVE STE 600
OKLAHOMA CITY, OK
ZIP 73112-090
Phone: (405) 713-9940
Fax: (405) 713-9941

The NPI 1093453565 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 5/24/2022 and was last updated on 1/12/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363AS0400X	Physician Assistant	Surgical	4800	OKLAHOMA	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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