MR. PHILLIP LEROY WAGNER MD NPI 1912931619

NPI Information

  • NPI: 1912931619
  • Provider Name: MR. PHILLIP LEROY WAGNER, MD
  • Classification: Preventive Medicine - 2083X0100X
  • Specialization: Occupational Medicine
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 975 SERENO DR
    OCCUPATIONAL MEDICINE
    VALLEJO, CA
    ZIP 94589
  • Phone: (707) 651-2243

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NPI Details

MR. Phillip Leroy Wagner, MD is an occupational medicine preventive medicine in Vallejo, CA. The provider is occupational medicine focuses on the health of workers, including the ability to perform work; the physical, chemical, biological, and social environments of the workplace; and the health outcomes of environmental exposures. Practitioners in this field address the promotion of health in the work place, and the prevention and management of occupational and environmental injury, illness, and disability. MR. Phillip Leroy Wagner, MD NPI is 1912931619. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

975 SERENO DR
OCCUPATIONAL MEDICINE
VALLEJO, CA
ZIP 94589-441
Phone: (707) 651-2243

The NPI 1912931619 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 7/10/2006 and was last updated on 12/15/2021.

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
12083X0100XPreventive MedicineOccupational Medicine20060083NEW MEXICOYes

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
1087585MEDICAIDARIZONA

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: 11/21/2025

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