Provider Demographics
NPI:1730244344
Name:WAGNER, LARS M (MD)
Entity type:Individual
Prefix:
First Name:LARS
Middle Name:M
Last Name:WAGNER
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Gender:M
Credentials:MD
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Mailing Address - Street 1:KENTUCKY CLINIC OFC J-457
Mailing Address - Street 2:740 S. LIMESTONE
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0284
Mailing Address - Country:US
Mailing Address - Phone:859-218-0931
Mailing Address - Fax:859-257-1888
Practice Address - Street 1:KENTUCKY CLINIC OFC J-457
Practice Address - Street 2:740 S. LIMESTONE
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0284
Practice Address - Country:US
Practice Address - Phone:859-218-0931
Practice Address - Fax:859-257-1888
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2013-11-01
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Provider Licenses
StateLicense IDTaxonomies
KY321692080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology