Wagner, Peter John
Wagner, Peter John is an individual health care provider with primary practice located at 39000 Bob Hope Dr , Rancho Mirage CA 92270-3221. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Behavioral Neurology & Neuropsychiatry, Allopathic & Osteopathic Physicians / Psychiatry. Allopathic & Osteopathic Physicians / Behavioral Neurology & Neuropsychiatry is his primary health care specialty. Wagner, Peter John can be contacted via phone (760) 837-8767.Contact Information
Primary practice address
39000 Bob Hope Dr
Rancho Mirage CA 92270-3221
Phone: (760) 837-8767
Fax: (760) 837-8806
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Behavioral Neurology & Neuropsychiatry | 2084B0040X | C130554 | California |
| Allopathic & Osteopathic Physicians / Behavioral Neurology & Neuropsychiatry | 2084B0040X | 36158 | Colorado |
| Allopathic & Osteopathic Physicians / Psychiatry | 2084P0800X | 36158 | Colorado |
| Allopathic & Osteopathic Physicians / Psychiatry | 2084P0800X | C130554 | California |
Profile Details
| NPI number | 1962403774 |
|---|---|
| LBN Legal business name | Wagner, Peter John |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 2nd, 2005 |
| Last updated | Nov 15th, 2021 - about 3 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 | 1962403774 | NPPES |
| Colorado | MEDICAID | 11902761 |
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