Individual
CHARLES JOHN WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1793 13TH ST SE, SALEM, OR 97302-2541
(503) 362-8385
(503) 362-8435
Mailing address
1793 13TH ST SE, SALEM, OR 97302-2541
(503) 362-8385
(503) 362-8435
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
OR14081
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
227660
—
OR
05
—
271171
—
OR
Enumeration date
09/20/2006
Last updated
07/05/2016
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