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General NPI Number Information
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NPI Number | 1871589283
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Entity Type | Individual
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Provider Name | STEPHEN M WAGGONER MD
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Gender | Male
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Dates
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Enumeration Date | 09/21/2005
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Last Update Date | 03/08/2021
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Provider Practice Location Address
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Address Line | 3045 KATE BOND RD
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City | BARTLETT
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State | TN
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Zip | 38133-4004
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Country | US
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Telephone | 901-381-4664
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Fax | 901-373-3804
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Provider Business Mailing Address
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Address Line | 6077 PRIMACY PKWY STE 140
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City | MEMPHIS
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State | TN
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Zip | 38119-5742
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Country | US
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Telephone | 901-259-1673
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Fax | 901-259-7637
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | MD0000025610
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | 25610
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License Number State | TN
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