MEDICARE: ANDREW STEPHEN WAGNER MD

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	207QH0002X	Hospice and Palliative Medicine (Family Medicine) Physician	G50907	CA

General Provider Information

NPI Number	:	1285722819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW STEPHEN WAGNER MD

Provider Business Mailing Address
First Line	:	30 MARK WEST SPRINGS RD
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-1436
Country	:	US
Telephone Number	:	707-235-6809
Fax Number	:	707-827-6327

Provider Business Practice Location Address
First Line	:	30 MARK WEST SPRINGS RD
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-1436
Country	:	US
Telephone Number	:	707-576-4000
Fax Number	:	707-827-6327

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

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	04/09/2025

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