Robert D Wagner, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

MD00020537 Issued in WA

Practice address

1690 Layton Rd
Freeland, WA 98249-9456

Phone

(360) 331-1314

Fax

(360) 331-9703

NPI assigned

Jun 27, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Pediatric Associates of Whidbey Island, PS

  • Pediatrics Physician
  • Oak Harbor, WA
  • NPI 1770700072
  NPD (past)
• Pediatric Associates of Whidbey Island, PS

  • Pediatrics Physician
  • Freeland, WA
  • NPI 1841759370
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559088000000",
    "number": "1285661983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "275 SE CABOT DR STE B102",
            "city": "OAK HARBOR",
            "state": "WA",
            "postal_code": "982773740",
            "telephone_number": "360-675-5555",
            "fax_number": "360-675-0275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1690 LAYTON RD",
            "city": "FREELAND",
            "state": "WA",
            "postal_code": "982499456",
            "telephone_number": "360-331-1314",
            "fax_number": "360-331-9703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "ROBERT",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-27",
        "last_updated": "2019-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WA",
            "license": "MD00020537",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1070135",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Terry M. Hansen, D.D.S., P.L.L.C.
• Diane Linda Thiel, MSW
• Jessica Tran, PHARMD
• David Vollan, PHYSICAL THERAPIST
• Ryan Martin Vos, L.AC.
• Susan Nellist Walker, MA CCC
• Rui Wang
• Washington CVS Pharmacy LLC
• Whidbey Island Public Hospital District
• Whidbey Island Public Hospital District

• Pediatrics Physician in Freeland, WA
• Providers in Freeland, WA by specialty
• Pediatrics Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.