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NPI Code Detail

MEDICARE: DR. BENJAMIN WAGNER CARLYLE M.D.

MEDICARE: DR. BENJAMIN WAGNER CARLYLE M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianE-7051AR
2208M00000XHospitalist PhysicianE-7051AR
3207R00000XInternal Medicine PhysicianE-7051AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1184882383
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BENJAMIN WAGNER CARLYLE M.D.
Provider Business Mailing Address
First Line : PO BOX 497
Second Line :
City : AUGUSTA
State : AR
Zip : 72006-0497
Country : US
Telephone Number : 870-347-2534
Fax Number :
Provider Business Practice Location Address
First Line : 3150 E HERITAGE PKWY STE 1
Second Line :
City : FARMINGTON
State : AR
Zip : 72730-5529
Country : US
Telephone Number : 479-400-1140
Fax Number : 479-400-1151
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2008
Last Update Date : 01/24/2025

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