# MATTHEW A WAGGONER

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1710991732
- **Gender:** Man
- **Credential:** P.A.-C.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | 4369 | WI | — |
| 363A00000X | Physician Assistant | 50002316 | OH | — |
| 363A00000X | Physician Assistant | 5601004953 | MI | Yes |

## Other

- **Enumeration date:** 07/27/2006
- **Last updated:** 04/18/2025