Organization
POPLAR HILL FAMILY PRACTICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT BASTIAN WAGNER MD (PRESIDENT)
(503) 638-8218
Entity
Organization
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
12/19/2006
Last updated
10/09/2007
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