Roy Marshall Wagner, DO Valid NPI
Individual provider · Family Medicine Physician · O Fallon, IL
- NPI
- 1477187383
- Type
- Individual (Type 1)
- Primary specialty
- Family Medicine Physician (Family Medicine)
- Specialty group
- Allopathic & Osteopathic Physicians
- Taxonomy code
- 207Q00000X
- License number
- 036164627 (IL)
- Sex
- Male
- Sole proprietor
- No
- Enumerated
- 2020-02-29
- Last updated
- 2023-11-07
Practice location
3 Saint Elizabeth Blvd Ste 4000
O Fallon, IL 62269
(618) 233-7880