Individual
STEPHEN M WAGGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3045 KATE BOND RD, BARTLETT, TN 38133-4004
(901) 381-4664
(901) 373-3804
Mailing address
6077 PRIMACY PKWY STE 140, MEMPHIS, TN 38119-5742
(901) 259-1673
(901) 259-7637
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
MD0000025610
TN
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
25610
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00760197
RR MEDICARE
TN
01
—
0151139
DOL
—
01
—
0547878
UNITED HEALTH
—
05
—
1514471
—
TN
01
—
2580550
CIGNA
—
01
—
4228383
BCBS OF TN
TN
01
—
96879
BCBSARK
—
Enumeration date
09/21/2005
Last updated
03/08/2021
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