Robert Bastian Wagner, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD08471 Issued in OR

Practice address

22490 SW Mountain Rd
West Linn, OR 97068-9619

Phone

(503) 638-8218

Fax

(503) 638-9698

NPI assigned

Aug 30, 2006

Sex

Male

Sole proprietor

No

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)

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.

• Poplar Hill Family Practice

  • Family Medicine Physician
  • West Linn, OR
  • NPI 1831253673
  NPD (past) Authorized official

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1205712000000",
    "number": "1730298647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22490 SW MOUNTAIN RD",
            "city": "WEST LINN",
            "state": "OR",
            "postal_code": "970689619",
            "telephone_number": "503-638-8218",
            "fax_number": "503-638-9698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22490 SW MOUNTAIN RD",
            "city": "WEST LINN",
            "state": "OR",
            "postal_code": "970689619",
            "telephone_number": "503-638-8218",
            "fax_number": "503-638-9698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "ROBERT",
        "middle_name": "BASTIAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2008-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "MD08471",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "214510",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Angela R Vinti, PHARMD, BCPS
• Virginia San Miguel MD PC (West Linn Women's Clinic)
• VVRX Pharmacy Billing Solutions LLC
• Terrence K Wager, PSY.D.
• Gary M Wagman, L. AC.
• Shelbie Rene Wallace, LPC
• Walmart Inc. (WalMart Pharmacy 10-5994)
• William Walters, PT
• Jordan Nicole Ward, LMT
• Denise Watkins, BS, RDH

• Family Medicine Physician in West Linn, OR
• Providers in West Linn, OR by specialty
• Family Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2008; 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.