Wagner, Robert

Wagner, Robert is an individual health care provider with primary practice located at 1361 W Fremont St , Galesburg IL 61401-2436. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Wagner, Robert can be contacted via phone (309) 344-2225.

Contact Information

Primary practice address
1361 W Fremont St Galesburg IL 61401-2436
Fax: (309) 344-2230
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 036051902 Illinois

Profile Details

NPI number 1588663017
LBN Legal business name Wagner, Robert
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 18th, 2005
Last updated May 11th, 2022 - about 2 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 1588663017 NPPES
Illinois MEDICAID 036051902

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