Individual
ROBERT WAGNER
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3100 CHANNING WAY, IDAHO FALLS, ID 83404-7533
(208) 535-4130
(208) 535-4125
Mailing address
PO BOX 1647, 22860 CHANNING WAY SUITE 115, IDAHO FALLS, ID 83403-1647
(208) 535-4130
(208) 535-4125
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
M5280
ID
207PE0005X
Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
Primary
M5280
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4012400
—
ID
01
—
57968
BLUE CROSS
ID
Enumeration date
01/20/2006
Last updated
09/11/2025
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