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NPI Code Detail

MEDICARE: ROBERT ALLAN WAGENECK DO

MEDICARE: ROBERT ALLAN WAGENECK DO
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
1207Q00000XFamily Medicine PhysicianN2875TX
2207Q00000XFamily Medicine PhysicianOP60971885WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2414072OTHERWALABOR AND INDUSTRIES

General Provider Information

NPI Number : 1861450314
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT ALLAN WAGENECK DO
Provider Business Mailing Address
First Line : 501 S 5TH AVE
Second Line :
City : YAKIMA
State : WA
Zip : 98902-3550
Country : US
Telephone Number : 509-853-1082
Fax Number : 509-573-6275
Provider Business Practice Location Address
First Line : 521 E MOUNTAIN VIEW AVE
Second Line :
City : ELLENSBURG
State : WA
Zip : 98926-3865
Country : US
Telephone Number : 509-962-1414
Fax Number : 509-962-1408
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2006
Last Update Date : 01/19/2021

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