MEDICARE: DR. LEE JAMES WAGNER JR. N.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	175F00000X	Naturopath	NT-1104	WA

General Provider Information

NPI Number	:	1275689283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEE JAMES WAGNER JR. N.D.

Provider Business Mailing Address
First Line	:	PO BOX 5933
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98227-5933
Country	:	US
Telephone Number	:	360-647-1831
Fax Number	:	360-647-1831

Provider Business Practice Location Address
First Line	:	119 N COMMERCIAL ST STE 315
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98225-4437
Country	:	US
Telephone Number	:	360-647-1831
Fax Number	:	360-647-1831

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

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	07/08/2007

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