Wagner, Mark Bastian
Wagner, Mark Bastian is an individual health care provider with primary practice located at 15755 Sw Sequoia Pkwy Suite 200, Tigard OR 97224-7166. He recently has 2 registered licenses in different health care specialties including Other Service Providers / Specialist, Allopathic & Osteopathic Physicians / Orthopaedic Surgery. Allopathic & Osteopathic Physicians / Orthopaedic Surgery is his primary health care specialty. Wagner, Mark Bastian can be contacted via phone (503) 639-6002.Contact Information
Primary practice address
15755 Sw Sequoia Pkwy Suite 200
Tigard OR 97224-7166
Phone: (503) 639-6002
Fax: (503) 639-1403
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Specialist | 174400000X | MD26810 | Oregon |
| Allopathic & Osteopathic Physicians / Orthopaedic Surgery | 207X00000X | MD26810 | Oregon |
Profile Details
| NPI number | 1891710869 |
|---|---|
| LBN Legal business name | Wagner, Mark Bastian |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 12th, 2006 |
| Last updated | Apr 7th, 2015 - about 10 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1891710869 | NPPES |
| Oregon | MEDICAID | 006033 | |
| Oregon | Other | 93-1280904 | |
| Oregon | Other | 1891710869 |
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