Drue O. Wagner, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

00028927 Issued in WA

Practice address

619 S Washington St
Suite 203
Moscow, ID 83843-3090

Phone

(208) 892-1346

Fax

(208) 892-8306

NPI assigned

Apr 10, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Community Healthcare of the Palouse

  • Family Medicine Physician
  • Moscow, ID
  • NPI 1346263308
  NPD (past)
• Wagner Indian Health Care Pharmacy

  • Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
  • Wagner, SD
  • NPI 1548390115
  NPD (past)
• Wagner Indian Health Service Health Center

  • Community Health Worker
  • Wagner, SD
  • NPI 1427707108
  NPD (past)

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

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549238400000",
    "number": "1891918629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 SE BISHOP BLVD",
            "address_2": "STE 901",
            "city": "PULLMAN",
            "state": "WA",
            "postal_code": "991635538",
            "telephone_number": "208-892-1346",
            "fax_number": "208-892-8306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "619 S WASHINGTON ST",
            "address_2": "SUITE 203",
            "city": "MOSCOW",
            "state": "ID",
            "postal_code": "838433090",
            "telephone_number": "208-892-1346",
            "fax_number": "208-892-8306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "DRUE",
        "middle_name": "O.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-10",
        "last_updated": "2019-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "00028927",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "M-11013",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1008218020002",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nora Vogt
• Tyler Hempfling Volkmann
• Beth Waddel, PH.D.
• Jennifer Wade, COUNSELOR INTERN
• Daren Wagner, RPH
• Walgreen Co (Walgreens #12503)
• Walgreen Co (Rite Aid #16660)
• Walter Rand Walker, PH.D.
• Ryan Joe Wallace, RT (R)
• Jacob Daniel Waller

• Family Medicine Physician in Moscow, ID
• Providers in Moscow, ID by specialty
• Family Medicine Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 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.