Individual
DAVID G. WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9250 SW HALL BLVD, TIGARD, OR 97223-6857
(503) 293-0161
(503) 452-3200
Mailing address
9250 SW HALL BLVD, TIGARD, OR 97223-6857
(503) 293-0161
(503) 452-3200
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD07158
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
240978
—
OR
Enumeration date
08/02/2006
Last updated
12/08/2010
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