Individual
DR. CHAD ERIC WAGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1615 HAZEL ST, CARTHAGE, MO 64836-3020
(417) 359-8803
(417) 359-8454
Mailing address
1615 HAZEL ST, CARTHAGE, MO 64836-3020
(417) 359-8803
(417) 359-8454
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2002017031
MO
Other
Enumeration date
10/19/2005
Last updated
11/15/2012
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