Wagner, James Everett

Wagner, James Everett is an individual health care provider with primary practice located at 1175 E Main St Ste 1C , Medford OR 97504-7457. He recently has only one registered license in Other Service Providers / Peer Specialist, which is considered as his primary health care specialty. Wagner, James Everett can be contacted via phone (541) 772-0127.

Contact Information

Primary practice address
1175 E Main St Ste 1C Medford OR 97504-7457
Phone: (541) 772-0127
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Peer Specialist 175T00000X

Profile Details

NPI number 1952842346
LBN Legal business name Wagner, James Everett
Credentials BS, QMHA
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 17th, 2017
Last updated Feb 26th, 2018 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1952842346 NPPES
Oregon MEDICAID 1952842346

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