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Next Update: Thursday, December 19, 2024 2:50 AM CST
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WAGNER, MICHAEL DAVID
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This verification service provides current data extracted by the Oklahoma State Board of Medical Licensure and Supervision (OSBMLS) from its own database. The data enclosed in the green box below is provided by and controlled entirely by the OSBMLS and therefore constitutes a primary source verification of licensure status as authentic as a direct inquiry to the OSBMLS. NPI# and hospital privileges (if any) are provided by the licensee and not verified.
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| Practice Address: |
835 SPRUCE STREET
SUITE B
ESPANOLA NM 87532
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| Phone #: |
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| Fax #: |
(405) 272-6985 |
| County: |
NOT OKLAHOMA |
| License: |
12325 |
| Dated: |
7/2/1979 |
| Expires: |
7/1/2002 |
| License Type: |
Medical Doctor |
| Specialty: |
Pulmonary Disease
Critical Care Medicine (Internal Medicine)
Internal Medicine |
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| Status: |
Inactive |
| Status Class: |
Expired License |
| Restricted to: |
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| Registered to Dispense: |
NO |
| Medical School: |
Univ Of NM Sch Of Med, Albuquerque Nm 87131 |
| Graduated: |
5 /
1978 |
| CME Year: |
2003 |
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Pending and/or Past Disciplinary Actions:
No Disciplinary Action Taken.
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All information below is entered by the licensee but not verified by the Oklahoma Medical Board.
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| Certifications: |
AMERICAN BOARD OF INTERNAL MEDICINE |
| New Patients: |
Contact licensee |
| Medicaid: |
Contact licensee |
| Medicare: |
Contact licensee |
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| HMO/PPO: |
None listed |
| Hospital Privileges: |
None listed |
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