Individual
FREDRICK CHARLES WAGNER
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9205 SW BARNES RD, PORTLAND, OR 97225-6603
(503) 216-2195
(503) 216-2196
Mailing address
975 SE SANDY BLVD, SUITE 200, PORTLAND, OR 97214-1308
(503) 963-2846
(503) 963-9505
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
MD09972
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
242487
—
OR
05
—
8236705
—
WA
Enumeration date
08/24/2005
Last updated
07/09/2007
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