Provider Demographics
NPI:1245222322
Name:WASNER, CODY KEITH (MD)
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:KEITH
Last Name:WASNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1648
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97440-1648
Mailing Address - Country:US
Mailing Address - Phone:541-242-4384
Mailing Address - Fax:541-463-2820
Practice Address - Street 1:1007 HARLOW RD STE 210
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-7126
Practice Address - Country:US
Practice Address - Phone:541-741-0387
Practice Address - Fax:541-242-4634
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2025-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OR12537207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR228395Medicaid
OR228395Medicaid
C94031Medicare UPIN
OR228395Medicaid