Individual
MELISSA WAGGENER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1500 S MAIN ST, FORT WORTH, TX 76104-4941
(817) 702-1100
Mailing address
1500 S MAIN ST, FORT WORTH, TX 76104-4941
(817) 702-1100
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
805977
TX
208600000X
Surgery Physician
Primary
43590
OK
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
11/17/2020
Last updated
03/06/2026
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