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NPI Code Detail

MEDICARE: CAMERON R WANGSGARD MD

MEDICARE: CAMERON R WANGSGARD 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
1207P00000XEmergency Medicine Physician52399AZ
2207P00000XEmergency Medicine Physician55503MN

General Provider Information

NPI Number : 1831485564
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAMERON R WANGSGARD MD
Provider Business Mailing Address
First Line : 200 1ST ST SW
Second Line :
City : ROCHESTER
State : MN
Zip : 55905-0001
Country : US
Telephone Number : 507-255-5607
Fax Number :
Provider Business Practice Location Address
First Line : 200 1ST ST SW
Second Line :
City : ROCHESTER
State : MN
Zip : 55905-5452
Country : US
Telephone Number : 507-284-2511
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2011
Last Update Date : 10/09/2020

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