Provider Demographics
NPI:1447401096
Name:WAGNER, AARON S (MD)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:S
Last Name:WAGNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:87 W JERSEY ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806
Mailing Address - Country:US
Mailing Address - Phone:407-422-1377
Mailing Address - Fax:407-422-1384
Practice Address - Street 1:87 W JERSEY ST
Practice Address - Street 2:SUITE 1
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806
Practice Address - Country:US
Practice Address - Phone:407-422-1377
Practice Address - Fax:407-422-1384
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME112962207ZN0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZN0500XAllopathic & Osteopathic PhysiciansPathologyNeuropathology