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General NPI Number Information
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NPI Number | 1295963999
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Entity Type | Individual
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Provider Name | MICHAEL WAGGONER DO
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Gender | Male
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Dates
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Enumeration Date | 07/01/2009
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Last Update Date | 06/14/2022
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Provider Practice Location Address
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Address Line | 3737 W WALNUT ST
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City | ROGERS
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State | AR
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Zip | 72756-1839
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Country | US
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Telephone | 479-246-1700
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Fax |
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Provider Business Mailing Address
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Address Line | 3318 N NORTHHILLS BLVD
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-4008
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Country | US
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Telephone | 479-521-2555
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 5341
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | E-8612
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License Number State | AR
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Taxonomy #3
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Taxonomy Code | 207WX0120X
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Taxonomy Name | Cornea and External Diseases Specialist Physician
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License Number | E-8612
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License Number State | AR
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | T2009017030
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License Number State | MO
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