Individual
DR. CARL WAGGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1272 W MAIN ST, BLDG. 5, NEWARK, OH 43055-2034
(740) 348-1788
(740) 348-1789
Mailing address
1272 W MAIN ST, BLDG. 5, NEWARK, OH 43055-2034
(740) 348-1788
(740) 348-1789
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35-043176
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0101480
UHC
OH
01
—
1822763
FIRST HEALTH
OH
05
—
416615
—
OH
01
—
4400430
AETNA
OH
Enumeration date
07/13/2005
Last updated
06/21/2010
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