Individual
STEPHEN DAVID WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3214 E RACE AVE, SEARCY, AR 72143-4810
(501) 268-6121
Mailing address
3214 E RACE AVE, SEARCY, AR 72143-4810
(501) 268-6121
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
E-9654
AR
208M00000X
Hospitalist Physician
Primary
E-9654
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
214517001
—
AR
Enumeration date
08/01/2012
Last updated
02/13/2018
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