MR. WILLIS H. WAGNER (NPI# 1003836248) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003836248 |
| Entity Type | Individual |
| Full Name | MR. WILLIS H. WAGNER |
| Credential | M.D. |
| Practice Address |
8631 W 3rd St Suite 615e Los Angeles CA 90048-5901 |
| Practice Telephone | 3106528132 |
| Practice Fax Number | 3106593815 |
| Mailing Telephone | 3106528132 |
| Mailing Fax Number | 3106593815 |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2007-10-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2086S0129X |
Surgery Specialization: Vascular Surgery |
G049464 | CA | Allopathic & Osteopathic Physicians |
| Street Address |
8631 W 3RD ST SUITE 615E |
| City | LOS ANGELES |
| State | CA |
| Zip Code | 90048-5901 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760481741 | Behnam David Massaband | Podiatrist | 8631 W 3rd St, Suite 940-e, Los Angeles, CA 90048-5901 | 2005-07-20 |
| 1073047155 | Drh Md Mph A Professional Medical Corporation | Specialist | 8631 W 3rd St, 1135e, Los Angeles, CA 90048-5917 | 2017-04-17 |
| 1083155592 | Colby Perkins Souders | Urology | 8631 W 3rd St, East Medical Office Tower, Suite 930, Los Angeles, CA 90048-5901 | 2017-03-16 |
| 1609326958 | Mls Audiology LLC | Audiologist | 8631 W 3rd St, Suite 312e, Los Angeles, CA 90048-5901 | 2016-10-11 |
| 1023565165 | Pegah Samouhi | Podiatrist | 8631 W 3rd St, Los Angeles, CA 90048-5901 | 2016-09-07 |
| 1669846556 | Tkmd Corp | Surgery | 8631 W 3rd St, Suite 200e, Los Angeles, CA 90048-5901 | 2015-11-16 |
| 1164893236 | Swaraj Bose, Md, Inc | Ophthalmology | 8631 W 3rd St, Suite 200e, Los Angeles, CA 90048-5901 | 2015-10-14 |
| 1821468125 | Ramin Youssefzadeh | Counselor | 8631 W 3rd St, 225e, Los Angeles, CA 90048-5901 | 2015-09-29 |
| 1679942817 | Stanley E. Kahan Md, PC | Internal Medicine | 8631 W 3rd St, Suite 735e, Los Angeles, CA 90048-5901 | 2015-09-17 |
| 1558737510 | Kapil Gupta Md A Professional Corporation | Clinic/Center | 8631 W 3rd St, #1015-e, Los Angeles, CA 90048-5901 | 2015-08-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609473420 | Alden Advanced Surgicenter LLC | Clinic/Center | 8741 Alden Drive, Suite B, Los Angeles, CA 90048 | 2020-10-05 |
| 1760090062 | New Dawn Tms Psychiatry | Clinic/Center | 640 S San Vincente Blvd, Ste. 210, Los Angeles, CA 90048 | 2020-07-22 |
| 1114547312 | Savannah Marie Gonzales | Student in an Organized Health Care Education/Training Program | 8700 Beverly Blvd Suite 3636, Los Angeles, CA 90048 | 2020-04-17 |
| 1861048613 | Sam Dawkins | Internal Medicine | Suite 415e, 8631 West Third Street, Los Angeles, CA 90048 | 2019-08-16 |
| 1295202638 | Caleb Rogers Penn | Anesthesiology | Cedars-sinai Department of Anesthesiology, 8700 Beverly Blvd, Los Angeles, CA 90048 | 2018-10-24 |
| 1437641727 | Medical Imaging Center of Southern California-beverly Hills, Inc | Radiology | 8727 Beverly Blvd, Los Angeles, CA 90048 | 2018-06-01 |
| 1689164121 | Maulin Shah | Student in an Organized Health Care Education/Training Program | 8700 Beverly Blvd Suite 5512, Los Angeles, CA 90048 | 2018-05-10 |
| 1013423631 | Abdul Ali Qaderi | Anesthesiology | 8700 Beverly Blvd Suite 4209, Los Angeles, CA 90048 | 2017-12-19 |
| 1619483559 | Sakeenah Hakim | Social Worker | 292 S. La Cienega Blvd, Suite 102, Los Angeles, CA 90048 | 2017-12-14 |
| 1851805048 | West Hollywood Medical Group Inc | General Practice | 8733 Beverly Blvd Suite #203, West Hollywood, CA 90048 | 2017-11-27 |
| Find all providers in zip 90048 | ||||
| Taxonomy Code | 2086S0129X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Vascular Surgery |
| A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881213817 | Robert Morton Carroll X | Surgery | 2241 Century Hl, Los Angeles, CA 90067-3506 | 2020-04-09 |
| 1467922120 | Paul Bressman Md Inc | Surgery | 1493 S Crest Dr, Los Angeles, CA 90035-3339 | 2018-11-26 |
| 1376905802 | Southern California Vascular Group, Inc | Surgery | 1530 Camden Ave Ste 403, Los Angeles, CA 90025-8010 | 2016-03-23 |
| 1407246408 | Richard Guest Md, A Professional Medical Corporation | Surgery | 15478 Duomo Via St, Los Angeles, CA 90077-1515 | 2015-01-28 |
| 1972948370 | Tri Star Orthopaedics | Surgery | 440 Shatto Pl # 419, Los Angeles, CA 90020-1793 | 2013-04-30 |
| 1831335363 | T J Fitzgibbons Md Inc | Surgery | 1245 Wilshire Blvd Ste 905, Los Angeles, CA 90017-4809 | 2009-01-06 |
| 1952553711 | Pablo Nankin | Surgery | 1125 S. Beverly Drive, Los Angeles, CA 90035 | 2008-10-10 |
| 1124210018 | Spencer Leland Brown | Surgery | 2080 Century Park E Ste 1807, Los Angeles, CA 90067-2021 | 2007-08-14 |
| 1518170240 | Wilbur Williams Jr. | Surgery | 1830 West Olympic Blvd, Suite 203, Los Angeles, CA 90006-3734 | 2007-05-08 |
| 1306968664 | Arthur Leonard Golding | Surgery | 1781 Old Ranch Rd, Los Angeles, CA 90049-2507 | 2007-04-05 |
| Find all providers in LOS ANGELES | ||||
| City | LOS ANGELES |
| Zip Code | 90048 |
Please comment or provide details below to improve the information on MR. WILLIS H. WAGNER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.