Individual
VITAS ERIK WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1708 YAKIMA AVE STE 105, TACOMA, WA 98405-5300
(253) 552-1200
(253) 552-1239
Mailing address
1708 YAKIMA AVE STE 105, TACOMA, WA 98405-5300
(253) 552-1200
(253) 552-1239
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
MD61176219
WA
208C00000X
Colon & Rectal Surgery Physician
Primary
MD61176219
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2189171
—
WA
Enumeration date
10/12/2017
Last updated
10/03/2025
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