Provider Demographics
NPI:1528228103
Name:WAGNER, JARED PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:PAUL
Last Name:WAGNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:636 VALLEY MALL PKWY STE 5
Mailing Address - Street 2:
Mailing Address - City:E WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98802-4898
Mailing Address - Country:US
Mailing Address - Phone:509-888-3496
Mailing Address - Fax:509-888-7428
Practice Address - Street 1:636 VALLEY MALL PKWY STE 5
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98802-4898
Practice Address - Country:US
Practice Address - Phone:425-362-9889
Practice Address - Fax:509-888-7428
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD60717768207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine