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General NPI Number Information
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NPI Number | 1285661983
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Entity Type | Individual
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Provider Name | ROBERT D WAGNER M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/27/2006
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Last Update Date | 05/29/2019
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Provider Practice Location Address
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Address Line | 1690 LAYTON RD
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City | FREELAND
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State | WA
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Zip | 98249-9456
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Country | US
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Telephone | 360-331-1314
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Fax | 360-331-9703
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Provider Business Mailing Address
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Address Line | 275 SE CABOT DR STE B102
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City | OAK HARBOR
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State | WA
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Zip | 98277-3740
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Country | US
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Telephone | 360-675-5555
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Fax | 360-675-0275
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD00020537
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License Number State | WA
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