MEDICARE: DR. KENDALL DARREN WAGNER 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
1	207RA0000X	Adolescent Medicine (Internal Medicine) Physician	E-8349	AR
2	208000000X	Pediatrics Physician	E-8349	AR
3	207R00000X	Internal Medicine Physician	E-8349	AR

Other Identifiers

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

General Provider Information

NPI Number	:	1699091264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENDALL DARREN WAGNER M.D.

Provider Business Mailing Address
First Line	:	11300 ROBERTS BLVD
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72916-6027
Country	:	US
Telephone Number	:	479-242-5910
Fax Number	:	479-688-0169

Provider Business Practice Location Address
First Line	:	11300 ROBERTS BLVD
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72916-6027
Country	:	US
Telephone Number	:	479-242-5910
Fax Number	:	479-688-0169

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2010
Last Update Date	:	06/13/2024

Similar Medicare Providers

1013871714 — PRIMARY CARE COLLECTIVE, PLLC
Practice Location Address:

11300 ROBERTS BLVD
FORT SMITH, AR
72916-6027

Practice Phone: 479-242-5910
Practice Fax: 479-668-0169

1649715681 — CHAFFEE DIAGNOSTICS LLC
Practice Location Address:

11300 ROBERTS BLVD
FORT SMITH, AR
72916-6027

Practice Phone: 479-434-6205
Practice Fax: 479-434-6210

1528721271 — KENDALL D. WAGNER, M.D., PLLC
Practice Location Address:

11300 ROBERTS BLVD
FORT SMITH, AR
72916-6027

Practice Phone: --
Practice Fax:

1255854485 — THEODORE REID
Practice Location Address:

1511 FORT DAVIS PL SE
WASHINGTON, DC
20020-6027

Practice Phone: 202-575-1513
Practice Fax:

1588187728 — BREANNA ANDERSON
Practice Location Address:

1511 FORT DAVIS PL SE
WASHINGTON, DC
20020-6027

Practice Phone: 202-575-1513
Practice Fax:

1518483718 — JEROME MAKUSON
Practice Location Address:

1511 FORT DAVIS PL SE
WASHINGTON, DC
20020-6027

Practice Phone: 240-504-5661
Practice Fax:

Directions to “ DR. KENDALL DARREN WAGNER M.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.