Individual
DR. CHRISTOPHER ROBERT WANGARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6800 STATE ROUTE 162, MARYVILLE, IL 62062-8521
(618) 288-5711
Mailing address
4165 FLORA PL, SAINT LOUIS, MO 63110-3605
(618) 304-4375
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036101921
IL
208000000X
Pediatrics Physician
112664
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036101921
—
IL
Enumeration date
08/30/2006
Last updated
09/17/2024
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