Provider Demographics
NPI:1538232046
Name:WAGNER, FRANKLIN C JR (MD)
Entity type:Individual
Prefix:DR
First Name:FRANKLIN
Middle Name:C
Last Name:WAGNER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:44777 S EL MACERO DR
Mailing Address - Street 2:
Mailing Address - City:EL MACERO
Mailing Address - State:CA
Mailing Address - Zip Code:95618-1035
Mailing Address - Country:US
Mailing Address - Phone:916-773-8700
Mailing Address - Fax:916-773-8701
Practice Address - Street 1:2 MEDICAL PLAZA DR
Practice Address - Street 2:SUITE 255
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3043
Practice Address - Country:US
Practice Address - Phone:916-773-8700
Practice Address - Fax:916-773-8701
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC40471207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
C40471OtherMEDICAL LICENSE
C40471OtherMEDICAL LICENSE