Individual
DR. BENJAMIN WAGNER CARLYLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3150 E HERITAGE PKWY STE 1, FARMINGTON, AR 72730-5529
(479) 400-1140
(479) 400-1151
Mailing address
PO BOX 497, AUGUSTA, AR 72006-0497
(870) 347-2534
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
E-7051
AR
207R00000X
Internal Medicine Physician
Primary
E-7051
AR
208M00000X
Hospitalist Physician
E-7051
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
190430001
—
AR
Enumeration date
05/26/2008
Last updated
01/24/2025
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