Provider Demographics
NPI:1245692086
Name:WAGNER, RYAN DAVID (MD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:DAVID
Last Name:WAGNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:24510 NORTHWEST FWY STE 630
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-2199
Mailing Address - Country:US
Mailing Address - Phone:325-333-7508
Mailing Address - Fax:832-533-3751
Practice Address - Street 1:24510 NORTHWEST FWY STE 630
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-2199
Practice Address - Country:US
Practice Address - Phone:325-333-7508
Practice Address - Fax:832-533-3751
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2024-10-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXV2315208200000X, 2082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery