Doctor Name: | DR. ERIKA ALYSE OVERBEEK WAGER |
NPI Number: | 1164794418 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | D.O. |
License Number: | 1063 |
Business Practice Address: | 1650 Cochrane Cir Iron Horse Family Medicine Clinic Fort Carson, CO - 809134604 |
Business Phone Number: | 7195244150 |
Business Fax Number: | 7195242258 |
Mailing Address: | 1650 Cochrane Cir, Iron Horse Family Medicine Clinic FORT CARSON |
State: | CO |
Postal Code: | 809134604 |
Phone Number: | 7195244150 |
Fax Number: | 7195242258 |
NPI Enumeration Date: | 02/02/2012 |
NPI Last Update Date: | 04/25/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 1063 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NE |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |