Provider Demographics
NPI:1295705986
Name:VAGNER, GREGG A (MD)
Entity type:Individual
Prefix:DR
First Name:GREGG
Middle Name:A
Last Name:VAGNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:6210 E HWY 290
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-1142
Mailing Address - Country:US
Mailing Address - Phone:512-338-3802
Mailing Address - Fax:512-406-6216
Practice Address - Street 1:1301 W 38TH ST STE 102
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705
Practice Address - Country:US
Practice Address - Phone:512-454-4561
Practice Address - Fax:512-406-7330
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3168207XS0106X, 2086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX173464203Medicaid
TX173464202Medicaid
TX173464201Medicaid