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Individual

MICHAEL WAGGONER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DO

Contact information

Practice address
3737 W WALNUT ST, ROGERS, AR 72756-1839
(479) 246-1700
Mailing address
3318 N NORTHHILLS BLVD, FAYETTEVILLE, AR 72703-4008
(479) 521-2555

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
T2009017030
MO
207W00000X
Ophthalmology Physician
5341
OK
207W00000X
Ophthalmology Physician
E-8612
AR
207WX0120X
Cornea and External Diseases Specialist Physician
Primary
E-8612
AR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200493810A
OK
Enumeration date
07/01/2009
Last updated
06/14/2022
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