Individual
TAMARA L WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 418-5700
Mailing address
8310 SW APPLE WAY APT D202, PORTLAND, OR 97225-1793
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD26710
OR
Other
Enumeration date
11/08/2006
Last updated
07/08/2007
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