Healthcare Provider Details

I. General information

NPI: 1609525864
Provider Name (Legal Business Name): ERIC LEE WAGNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7345 S PIERCE ST STE 205
LITTLETON CO
80128-4592
US

IV. Provider business mailing address

7345 S PIERCE ST STE 205
LITTLETON CO
80128-4592
US

V. Phone/Fax

Practice location:
  • Phone: 720-432-0958
  • Fax: 720-432-0978
Mailing address:
  • Phone: 720-432-0958
  • Fax: 720-432-0978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberDR.0077247
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD484773
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: