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Organization

POPLAR HILL FAMILY PRACTICE

Active
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Organization

POPLAR HILL FAMILY PRACTICE

Active
Organization subpart
No

Provider details

NPI number
Authorized official
ROBERT BASTIAN WAGNER MD (PRESIDENT)
(503) 638-8218
Entity
Organization

Contact information

Practice address
22490 SW MOUNTAIN RD, WEST LINN, OR 97068-9619
(503) 638-8218
(503) 638-9698
Mailing address
22490 SW MOUNTAIN RD, WEST LINN, OR 97068-9619
(503) 638-8218
(503) 638-9698

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD08471
OR

Other

Enumeration date
12/19/2006
Last updated
10/09/2007
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