Provider Demographics
NPI:1285899401
Name:WAGNER, AUSTIN J (DO)
Entity type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:J
Last Name:WAGNER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 NE RALPH POWELL RD STE D
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64064-2369
Mailing Address - Country:US
Mailing Address - Phone:816-675-0920
Mailing Address - Fax:
Practice Address - Street 1:3600 NE RALPH POWELL RD STE D
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064-2369
Practice Address - Country:US
Practice Address - Phone:816-675-0920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-28
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-416442086S0129X
MO20150073782086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery