Individual
ROBERT BASTIAN WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
22490 SW MOUNTAIN RD, WEST LINN, OR 97068-9619
(503) 638-8218
(503) 638-9698
Mailing address
22490 SW MOUNTAIN RD, WEST LINN, OR 97068-9619
(503) 638-8218
(503) 638-9698
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD08471
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
214510
—
OR
Enumeration date
08/30/2006
Last updated
03/17/2008
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