Healthcare Provider Details

I. General information

NPI: 1215901897
Provider Name (Legal Business Name): ROBERT ALLAN WASCHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 04/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14200 W CELEBRATE LIFE WAY
GOODYEAR AZ
85338-3007
US

IV. Provider business mailing address

14200 W CELEBRATE LIFE WAY
GOODYEAR AZ
85338-3007
US

V. Phone/Fax

Practice location:
  • Phone: 623-207-3217
  • Fax: 623-207-3379
Mailing address:
  • Phone: 623-207-3217
  • Fax: 623-207-3379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberA47782
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number25MA08122800
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number45166
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: