Matthew Dale Wagner M.D.

NPI 1487869996 - Urology - 208800000X

NPI Details
NPI 1487869996
Gender Male
Enumeration Date 05/10/2007
Last Updated 07/08/2007
Entity Type Individual
Active Over 9 years ago
Practice Location
PORTLAND OR, 97239-4501, US
Phone (503) 494-8311
Fax (503) 494-8671
Business Location
1836 SE 36TH AVE
PORTLAND OR, 97214-5128, US
Phone (503) 525-5833
Taxonomy Code 208800000X
License State Oregon
License Number LL16353
Remove 1487869996 NPI Number

According to our database, Dr. Matthew Dale Wagner M.D. NPI is 1487869996, taxonomy code is 208800000X and license number is LL16353, license state is located at Oregon. Matthew Dale Wagner M.D. physically located at 3303 Sw Bond Ave, Portland OR, 97239-4501. NPI Number Matthew Dale Wagner M.D. has the Individual type.

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1487869996 NPI number is provided on an as is basis without warranty of any kind. 1487869996 is maintained by the National Plan & Provider Enumeration System. The contents of Matthew Dale Wagner M.D. are for informational purposes only.