Individual
PETER JOHN WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
39000 BOB HOPE DR, RANCHO MIRAGE, CA 92270-3221
(760) 837-8767
(760) 837-8806
Mailing address
39000 BOB HOPE DR, RANCHO MIRAGE, CA 92270-3221
(760) 837-8767
(760) 837-8806
Taxonomy
Speciality
Code
Description
License number
State
2084B0040X
Behavioral Neurology & Neuropsychiatry Physician
36158
CO
2084B0040X
Behavioral Neurology & Neuropsychiatry Physician
Primary
C130554
CA
2084P0800X
Psychiatry Physician
36158
CO
2084P0800X
Psychiatry Physician
C130554
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11902761
—
CO
Enumeration date
08/02/2005
Last updated
11/15/2021
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