Paul D Wagner M D Inc

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

G77188 Issued in CA

Legal business name

PAUL D WAGNER M D INC

Practice address

4060 Fourth Ave
Suite 100
San Diego, CA 92103-2120

Phone

(619) 718-9444

Fax

(619) 718-9440

NPI assigned

Nov 16, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Connie Johnson

Title

Office MGR

Phone

(619) 718-9444

Specialties & licenses 1

Addresses

Other names 1

• San Diego Medical Group Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668384000000",
    "number": "1043383144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4060 FOURTH AVE",
            "address_2": "SUITE 100",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921032120",
            "telephone_number": "619-718-9444",
            "fax_number": "619-718-9440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4060 FOURTH AVE",
            "address_2": "SUITE 100",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921032120",
            "telephone_number": "619-718-9444",
            "fax_number": "619-718-9440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAUL D WAGNER M D INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-16",
        "last_updated": "2022-11-14",
        "certification_date": "2022-11-14",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "CONNIE",
        "authorized_official_title_or_position": "OFFICE MGR",
        "authorized_official_telephone_number": "619-718-9444"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G77188",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "San Diego Medical Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "San Diego Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Natasha Muse Patus, LMFT
• Bharati Patwardhan, LMFT
• Utsav Patwardhan, M.D.
• Sophie Patzek, M.D,
• Paul C. Murphy, M.D., Inc.
• Paul E Kim MD Inc
• Paul J Marsh Chiropractic Corporation
• Paul J Smith MD Apc
• Paul J.Wesling, O.D., Inc.
• Paul Luczynski DDS Inc

• Internal Medicine Physician in San Diego, CA
• Providers in San Diego, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.