Provider Demographics
NPI:1518286657
Name:WAGNER, KENNETH F (DO)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:F
Last Name:WAGNER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 GULFVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ISLAMORADA
Mailing Address - State:FL
Mailing Address - Zip Code:33036-4113
Mailing Address - Country:US
Mailing Address - Phone:305-664-0666
Mailing Address - Fax:305-664-3762
Practice Address - Street 1:206 GULFVIEW DR
Practice Address - Street 2:
Practice Address - City:ISLAMORADA
Practice Address - State:FL
Practice Address - Zip Code:33036-4113
Practice Address - Country:US
Practice Address - Phone:305-664-0666
Practice Address - Fax:305-664-3762
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-28
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5441207RI0200X
MDH0038875207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease