Daniel Jay Wagner, MD

Primary specialty

DentistTaxonomy code 122300000X

License

LNO3646 Issued in AL

Practice address

1303 Dr Martin L King Jr Ave
Mobile, AL 36603-5341

Phone

(251) 432-4112

Fax

(251) 964-4012

NPI assigned

Jun 29, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1151539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1528096492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2048",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366522048",
            "telephone_number": "251-432-4117",
            "fax_number": "251-964-4012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1303 DR MARTIN L KING JR AVE",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366035341",
            "telephone_number": "251-432-4112",
            "fax_number": "251-964-4012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "DANIEL",
        "middle_name": "JAY",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AL",
            "license": "LNO3646",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6314000180",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mason Alexander Wade, CRNP
• Philip M. Wade, MD
• Tiffany Harris Wade, FNP-C
• Deena Wafadari R, M.D.
• Anna Waggener, LPC
• Patti Ann Wagner
• Ruth Hattie Wagner, CRNP
• Donald W Wagnon Jr., M.D.
• Chia Kiryan Wain
• Samantha K Waite

• All providers in Mobile, AL
• Dentist in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.