Individual
DR. KENDALL DARREN WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11300 ROBERTS BLVD, FORT SMITH, AR 72916-6027
(479) 242-5910
(479) 688-0169
Mailing address
11300 ROBERTS BLVD, FORT SMITH, AR 72916-6027
(479) 242-5910
(479) 688-0169
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
E-8349
AR
207RA0000X
Adolescent Medicine (Internal Medicine) Physician
E-8349
AR
208000000X
Pediatrics Physician
E-8349
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
202855001
—
AR
Enumeration date
04/07/2010
Last updated
06/13/2024
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