MEDICARE: DR. ROBERT WAGNER CALHOUN PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	814	CO

General Provider Information

NPI Number	:	1679612220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT WAGNER CALHOUN PH.D.

Provider Business Mailing Address
First Line	:	704 HIGHLAND PLACE RD
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-1551
Country	:	US
Telephone Number	:	970-484-1481
Fax Number	:

Provider Business Practice Location Address
First Line	:	1302 S SHIELDS ST
Second Line	:	UNIT A2-2
City	:	FORT COLLINS
State	:	CO
Zip	:	80521-4801
Country	:	US
Telephone Number	:	970-493-8006
Fax Number	:	970-493-8009

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	07/08/2007

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