Provider Demographics
NPI:1952053886
Name:WAGER, CAITLIN (RT(R)(CT)(MR))
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:WAGER
Suffix:
Gender:F
Credentials:RT(R)(CT)(MR)
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RT(R)(CT)
Mailing Address - Street 1:2420 WESTSIDE RD
Mailing Address - Street 2:
Mailing Address - City:CAMAS VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97416-9720
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2420 WESTSIDE RD
Practice Address - Street 2:
Practice Address - City:CAMAS VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97416-9720
Practice Address - Country:US
Practice Address - Phone:541-733-2412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR9152902085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology