Individual
MR. WESLEY ALLEN WAGAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
711 S AUBURN ST, KENNEWICK, WA 99336-5665
(509) 586-2828
(509) 586-2525
Mailing address
711 S AUBURN ST, KENNEWICK, WA 99336-5665
(509) 586-2828
(509) 586-2525
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
PA01111
OR
363AS0400X
Surgical Physician Assistant
Primary
PA10004591
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8381717
—
WA
Enumeration date
06/07/2006
Last updated
05/02/2016
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