Individual
ROBERT LEE WAGNER JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9850 GENESEE AVE STE 820, LA JOLLA, CA 92037-1219
(858) 454-5442
(858) 431-4633
Mailing address
FILE # 54433, LOS ANGELES, CA 90074-0001
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
G41244
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00728781
RAILROAD MEDICARE
CA
Enumeration date
07/31/2006
Last updated
01/07/2020
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