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Individual

DR. MATTHEW DALE WAGNER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
9900 SE SUNNYSIDE RD, CLACKAMAS, OR 97015-9777
(800) 813-2000
(855) 524-5255
Mailing address
500 NE MULTNOMAH ST STE 100, PORTLAND, OR 97232-2031
(800) 813-2000
(855) 524-5255

Taxonomy

Speciality
Code
Description
License number
State
208800000X
Urology Physician
LL16353
OR
208800000X
Urology Physician
Primary
MD28198
OR
208800000X
Urology Physician
MD60003290
WA

Other

Enumeration date
05/10/2007
Last updated
09/08/2025
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