# POPLAR HILL FAMILY PRACTICE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1831253673
- **Authorized official:** ROBERT BASTIAN WAGNER MD (PRESIDENT)
- **Authorized official phone:** (503) 638-8218

## Contact information

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

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | MD08471 | OR | Yes |

## Other

- **Enumeration date:** 12/19/2006
- **Last updated:** 10/09/2007