Wagner, Robert

Wagner, Robert is an individual health care provider with primary practice located at 3100 Channing Way , Idaho Falls ID 83404-7533. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Emergency Medicine, Allopathic & Osteopathic Physicians / Undersea and Hyperbaric Medicine. Allopathic & Osteopathic Physicians / Emergency Medicine is his primary health care specialty. Wagner, Robert can be contacted via phone (208) 535-4130.

Contact Information

Primary practice address
3100 Channing Way Idaho Falls ID 83404-7533
Phone: (208) 535-4130
Fax: (208) 535-4125
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X M5280 Idaho
Allopathic & Osteopathic Physicians / Undersea and Hyperbaric Medicine 207PE0005X M5280 Idaho

Profile Details

NPI number 1578543989
LBN Legal business name Wagner, Robert
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 20th, 2006
Last updated Jul 8th, 2007 - about 17 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1578543989 NPPES
Idaho Other 57968 BLUE CROSS
Idaho MEDICAID 4012400 BLUE CROSS

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