Individual
DR. BENJAMIN ROBERT WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4301 W MARKHAM ST # 584, LITTLE ROCK, AR 72205-7101
(501) 686-6996
Mailing address
101 E WOOD ST, SPARTANBURG, SC 29303-3040
(864) 560-6000
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
88523
SC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/31/2019
Last updated
08/04/2022
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