Individual
MR. MATTHEW DAVID WAGAMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1034 N 500 W, PROVO, UT 84604-3380
(801) 357-7850
(770) 701-6675
Mailing address
PO BOX 3570, SALT LAKE CITY, UT 84110-3570
(801) 727-2056
(770) 701-6675
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
22241
ND
207L00000X
Anesthesiology Physician
4301096041
MI
207L00000X
Anesthesiology Physician
9395169-1205
UT
Other
Enumeration date
05/10/2011
Last updated
09/24/2025
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