Provider Demographics
NPI:1841287570
Name:WAGENAAR, ROBERT S (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:WAGENAAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2903 LEGACY LN
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59105-5561
Mailing Address - Country:US
Mailing Address - Phone:406-850-8333
Mailing Address - Fax:406-578-1202
Practice Address - Street 1:2795 ENTERPRISE AVE STE 5
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-7479
Practice Address - Country:US
Practice Address - Phone:406-701-1111
Practice Address - Fax:406-578-1202
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MT9968207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I32791Medicare UPIN
MT000084751Medicare ID - Type Unspecified