Provider Demographics
NPI:1770701617
Name:WAGERS, SCOTT S
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:S
Last Name:WAGERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WEG NAAR GENEUTH 95
Mailing Address - Street 2:
Mailing Address - City:MAASMECHELEN
Mailing Address - State:LIMBURG
Mailing Address - Zip Code:3630
Mailing Address - Country:BE
Mailing Address - Phone:328-924-8254
Mailing Address - Fax:
Practice Address - Street 1:1400 S DOBSON RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4707
Practice Address - Country:US
Practice Address - Phone:480-835-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ36542207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTG67190Medicare UPIN