Individual
MATTHEW WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1701 CLUB MANOR DR STE 2B, MAUMELLE, AR 72113
(501) 812-7216
Mailing address
1701 CLUB MANOR DR STE 2B, MAUMELLE, AR 72113-7401
(501) 812-7216
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
E-11361
AR
Other
Enumeration date
06/17/2015
Last updated
09/04/2018
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