Wagner, Charles Wesley
Wagner, Charles Wesley is an sole proprietor health care provider with primary practice located at 12609 Saint Charles Blvd , Little Rock AR 72211-2227. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatric Surgery, which is considered as his primary health care specialty. Wagner, Charles Wesley can be contacted via phone (501) 680-0738.Contact Information
Primary practice address
12609 Saint Charles Blvd
Little Rock AR 72211-2227
Phone: (501) 680-0738
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatric Surgery | 2086S0120X | N-7036 | Arkansas |
Profile Details
| NPI number | 1003532268 |
|---|---|
| LBN Legal business name | Wagner, Charles Wesley |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Oct 18th, 2022 |
| Last updated | Oct 18th, 2022 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1003532268 | NPPES |
| Arkansas | Other | N-7036 | GENERAL PRACTICE |
| Arkansas | MEDICAID | N-7036 | GENERAL PRACTICE |
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