Basic Information
| Provider Information | |||||||||
| NPI: | 1275682429 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WAGER | ||||||||
| FirstName: | GAEL | ||||||||
| MiddleName: | PATRICIA | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD, MPH, MBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 933 BRADBURY SE | ||||||||
| Address2: | SUITE 2222 | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871064375 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052723120 | ||||||||
| FaxNumber: | 5052728060 | ||||||||
| Practice Location | |||||||||
| Address1: | 2211 LOMAS BLDS. NE | ||||||||
| Address2: | 4TH FLOOR AMBULATORY CARE CTR | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 87106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052722245 | ||||||||
| FaxNumber: | 5052721109 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2007 | ||||||||
| LastUpdateDate: | 01/31/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VM0101X | 19603 | AZ | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine | 207VM0101X | MD2011-0010 | NM | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine |
ID Information
| ID | Type | State | Issuer | Description | AW8706484 | 01 | DEA | OTHER | 297889 | 05 | AZ | MEDICAID |