PETER JOHN WAGNER M.D. NPI 1962403774

NPI Information

NPI: 1962403774
Provider Name: PETER JOHN WAGNER, M.D.
Classification: Psychiatry & Neurology - 2084B0040X
Entity Type: Individual

Specialization: Behavioral Neurology & Neuropsychiatry

Organization: EISENHOWER MEDICAL CENTER

PECOS Registration: Yes

Address:
39000 BOB HOPE DR
RANCHO MIRAGE, CA
ZIP 92270
Phone: (760) 837-8767
Get Directions

Peter John Wagner, M.D. is a behavioral neurology and neuropsychiatry psychiatry neurology in Rancho Mirage, CA with 29 years of experience. The provider is behavioral Neurology & Neuropsychiatry is a medical subspecialty involving the diagnosis and treatment of neurologically based behavioral issues. Peter John Wagner, M.D. NPI is 1962403774. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: UNIVERSITY OF COLORADO SCHOOL OF MEDICINE, DENVER
Graduation Year:1995

The provider's business location address is:

39000 BOB HOPE DR
RANCHO MIRAGE, CA
ZIP 92270-221
Phone: (760) 837-8767
Fax: (760) 837-8806

The NPI 1962403774 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 8/2/2005 and was last updated on 11/15/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2084B0040X	Psychiatry & Neurology	Behavioral Neurology & Neuropsychiatry	C130554	CALIFORNIA	Yes
2	2084B0040X	Psychiatry & Neurology	Behavioral Neurology & Neuropsychiatry	36158	COLORADO	No
3	2084P0800X	Psychiatry & Neurology	Psychiatry	36158	COLORADO	No
4	2084P0800X	Psychiatry & Neurology	Psychiatry	C130554	CALIFORNIA	No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	11902761	MEDICAID	COLORADO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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