Individual
STEPHEN ALAN WAGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3015 SQUALICUM PKWY, BELLINGHAM, WA 98225-1945
(360) 738-2200
(360) 752-5687
Mailing address
PO BOX 5096, BELLINGHAM, WA 98227-5096
(360) 738-2200
(360) 752-5687
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
12538
ME
207V00000X
Obstetrics & Gynecology Physician
Primary
MD00018942
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001047
ANTHEM
ME
01
—
010212444
TAX ID #
ME
01
—
0244685
L&I AND CRIME VICTIMS
WA
01
—
1699860270
GROUP NPI #
ME
01
—
1861587305
INDIVIDUAL NPI #
ME
05
—
1861587305
—
WA
05
—
315910099
—
ME
01
—
3296WA
REGENCE
WA
01
—
5196237
AETAN
WA
05
—
8532970
—
WA
01
—
MM9730
MEDICARE GROUP #
ME
Enumeration date
10/03/2006
Last updated
11/19/2010
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