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NPI Code Detail

MEDICARE: DR. ERIKA ALYSE OVERBEEK WAGER D.O.

MEDICARE: DR. ERIKA ALYSE OVERBEEK WAGER D.O.
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
1208D00000XGeneral Practice Physician1063NE
2207Q00000XFamily Medicine PhysicianDR.0060136CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1028918OTHERCOKAISER COMMERCIAL NUMBER

General Provider Information

NPI Number : 1164794418
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ERIKA ALYSE OVERBEEK WAGER D.O.
Provider Business Mailing Address
First Line : 1650 COCHRANE CIR
Second Line : IRON HORSE FAMILY MEDICINE CLINIC
City : FORT CARSON
State : CO
Zip : 80913-4604
Country : US
Telephone Number : 719-524-4150
Fax Number : 719-524-2258
Provider Business Practice Location Address
First Line : 320 E FONTANERO ST STE 100
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80907-7535
Country : US
Telephone Number : 719-365-7420
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/02/2012
Last Update Date : 06/22/2022

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