Glenn Norman Wagner, DO

Primary specialty

Independent Medical Examiner PhysicianTaxonomy code 202C00000X

License

20A4111 Issued in CA

Practice address

5570 Overland Ave Ste 101
San Diego, CA 92123-1215

Phone

(858) 694-2899

Fax

(858) 694-2514

NPI assigned

Aug 29, 2017

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Osteopathy

State licenses

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

{
    "created_epoch": "1503964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1235656323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5570 OVERLAND AVE STE 101",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921231215",
            "telephone_number": "858-694-2899",
            "fax_number": "858-694-2514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5570 OVERLAND AVE STE 101",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921231215",
            "telephone_number": "858-694-2899",
            "fax_number": "858-694-2514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "GLENN",
        "middle_name": "NORMAN",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-08-29",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "202C00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Independent Medical Examiner",
            "state": "CA",
            "license": "20A4111",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deborah Abblitt Wagner
• Deborah Jessica Wagner, LCSW
• Elizabeth Forsythe Wagner, MSPT
• Felipe Victora Wagner, MD
• Gabriel Arturo Wagner, M.D.
• Hannah Katelyn Wagner
• Jeffrey Wagner, LPCC
• Jessica Grace Wagner, PT, DPT
• Katelin Wagner
• Kimberly Eileen Wagner, M.A.

• Independent Medical Examiner Physician in San Diego, CA
• Providers in San Diego, CA by specialty
• Independent Medical Examiner Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.