Healthcare Provider Details

I. General information

NPI: 1710983291
Provider Name (Legal Business Name): ARMIN JARED WAGMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 02/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 S NATIONAL AVE # C-100
SPRINGFIELD MO
65810-2607
US

IV. Provider business mailing address

1301 CONCORD TER
SUNRISE FL
33323-2843
US

V. Phone/Fax

Practice location:
  • Phone: 417-447-4700
  • Fax: 417-447-4701
Mailing address:
  • Phone: 800-243-3839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberR3P31
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: