Jerad Scott Wagner, PA-C

NPI #1932448347 in Ardmore, Oklahoma

Provider Information

NPI Number: 1932448347
Entity Type: Individual
Name: Jerad Scott Wagner, PA-C
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physician Assistant
Credential: PA-C
Enumeration Date: Feb 5, 2013
Last Updated: Jan 27, 2016

Practice Location

Address: 921 14TH AVE NW
City: Ardmore
State: Oklahoma
ZIP Code: 73401-1837
Phone: (580) 223-5311

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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