Individual
COLIN JOHN VAN WAGONER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1625 N CAMPBELL AVE, TUCSON, AZ 85719-4330
(520) 694-0111
Mailing address
1107 E ROUND MOUNTAIN DR, ALPINE, UT 84004-1846
(801) 656-7560
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
—
AZ
Other
Enumeration date
04/17/2026
Last updated
04/17/2026
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