Individual
DR. DRUE O. WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
619 S WASHINGTON ST, SUITE 203, MOSCOW, ID 83843-3090
(208) 892-1346
(208) 892-8306
Mailing address
825 SE BISHOP BLVD, STE 901, PULLMAN, WA 99163-5538
(208) 892-1346
(208) 892-8306
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
00028927
WA
207Q00000X
Family Medicine Physician
M-11013
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1008218020002
—
PA
Enumeration date
04/10/2007
Last updated
02/04/2019
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