MATTHEW WAGNER (NPI# 1790166445) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790166445 |
| Entity Type | Individual |
| Full Name | MATTHEW WAGNER |
| Credential | M.D. |
| Practice Address |
1701 Club Manor Dr Ste 2b Maumelle AR 72113 |
| Mailing Address |
1701 Club Manor Dr Ste 2b Maumelle AR 72113-7401 |
| Practice Telephone | 5018127216 |
| Mailing Telephone | 5018127216 |
| Enumeration Date | 2015-06-17 |
| Last Update Date | 2018-09-04 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | E-11361 | AR | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1010 N Kansas St, Wichita, KS 672143124 | 3162932665 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578052866 | Matthew Robert Wagner | Dentist | 2830 Curry Ln #1, Green Bay, WI 54311 | 2018-05-02 |
| 1538534334 | Matthew Wagner | Acupuncturist | 4513 Vernon Blvd, Madison, WI 53705-4993 | 2015-12-04 |
| 1053749168 | Matthew Wagner | Counselor | 545 N Mcdonough St Ste 212, Decatur, GA 30030-3310 | 2013-10-29 |
| 1114198751 | Matthew Robert Wagner | Orthopaedic Surgery | 1500 Route 112 Bldg 2c, Port Jefferson Station, NY 11776-8055 | 2008-03-21 |
| 1700415965 | Matthew Anthony Wagner | Student in an Organized Health Care Education/Training Program | 1500 E Sherman Blvd, Muskegon, MI 49444-1849 | 2020-04-08 |
| 1376177048 | Matthew Gary Wagner | Case Manager/Care Coordinator | 16 W Long St, Columbus, OH 43215-2815 | 2020-03-02 |
| 1235613738 | Matthew James Wagner | Pharmacist | 17213 Cole Rd, Hagerstown, MD 21740-6981 | 2018-09-20 |
| 1164918199 | Matthew Steven Wagner | Internal Medicine | 5225 23rd Ave S, Fargo, ND 58104-7927 | 2018-07-02 |
| 1609371244 | Matthew Anthony Wagner | Student in an Organized Health Care Education/Training Program | 509 Biltmore Ave, Asheville, NC 28801-4601 | 2018-03-26 |
| 1669994752 | Matthew Wagner | Behavior Technician | 415 Medical Dr Ste D101, Bountiful, UT 84010-8905 | 2017-07-11 |
| Street Address |
1701 CLUB MANOR DR STE 2B |
| City | MAUMELLE |
| State | AR |
| Zip Code | 72113 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932118890 | Arkansas Health Group | Internal Medicine | 1701 Club Manor Dr Ste 2b, Maumelle, AR 72113-7401 | 2006-08-07 |
| 1063935245 | Shamna Mohammed | Internal Medicine | 1701 Club Manor Dr Ste 2b, Maumelle, AR 72113-7401 | 2017-07-19 |
| 1578096905 | Lovepreet Singh | Internal Medicine | 1701 Club Manor Dr Ste 2b, Maumelle, AR 72113-7401 | 2017-04-03 |
| 1477938009 | Anna Szwedo | Internal Medicine | 1701 Club Manor Dr Ste 2b, Maumelle, AR 72113 | 2015-07-24 |
| 1629450127 | Sultan Singh Chhina | Internal Medicine | 1701 Club Manor Dr Ste 2b, Maumelle, AR 72113 | 2015-06-22 |
| 1497160691 | Muhammad Ressam Nazir | Internal Medicine | 1701 Club Manor Dr Ste 2b, Maumelle, AR 72113 | 2014-06-25 |
| 1174752554 | Onyedika John Ilonze | Internal Medicine | 1701 Club Manor Dr Ste 2b, Maumelle, AR 72113 | 2009-07-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104347814 | Shasta Dockery | Registered Nurse | 15020 Wade Blvd., North Little Rock, AR 72113 | 2017-07-03 |
| 1235669839 | Robert Mitchell Fisher | Specialist/Technologist | 134 Vienne Pl, Maumelle, AR 72113 | 2017-06-15 |
| 1932516887 | Healthcare Express, LLP | Clinic/Center | 11819 Maumelle Blvd., North Little Rock, AR 72113 | 2014-07-11 |
| 1184997991 | Preston Lewis | Speech-Language Pathologist | 14 Braeswood Place, Maumelle, AR 72113 | 2012-02-10 |
| 1740437813 | Jennifer L Franklin | Social Worker | 115 Audubon Dr Ste 9a, Maumelle, AR 72113 | 2008-08-20 |
| 1861655912 | Dawn Melton Mulkern | Dietitian, Registered | 12 Ninth Fairway Loop, Maumelle, AR 72113 | 2008-07-09 |
| 1902028723 | Robin Reynolds | Dietitian, Registered | 9300 White Oak Crossing, N Little Rock, AR 72113 | 2007-05-02 |
| 1316096498 | Caretech Medical, Inc. | Durable Medical Equipment & Medical Supplies | 8010 Counts Massie Rd, Suite B, North Little Rock, AR 72113 | 2007-01-09 |
| 1548318470 | Supermarket Investors Inc | Pharmacy | 1117 Audubon Dr, Maumelle, AR 72113 | 2007-01-08 |
| 1821177353 | Maumelle Investments & Associates, LLC | Skilled Nursing Facility | 103 Alexandria Drive, Maumelle, AR 72113 | 2006-11-03 |
| Find all providers in zip 72113 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720146509 | John M Brown | Family Medicine | 1701 Club Manor Dr Ste 2, Maumelle, AR 72113-7401 | 2006-12-05 |
| 1073616934 | Jeffrey John Carfagno | Family Medicine | 1900 Club Manor Dr Ste 105, Maumelle, AR 72113-7443 | 2006-09-06 |
| 1073629408 | Maumelle Medical Clinic | Family Medicine | 600 Pine Forest Dr, Ste 200, Maumelle, AR 72113-6910 | 2006-08-21 |
| 1922016674 | Fred G Nagel Jr. | Family Medicine | 1701 Club Manor Dr, Suite 2, Maumelle, AR 72113-7400 | 2006-08-04 |
| 1659340826 | Billy Reid Mcbay | Family Medicine | 501 Millwood Cir, Suite E, Maumelle, AR 72113-6327 | 2006-03-17 |
| 1467573360 | Abeer Salman Hashmi | Family Medicine | 501 Millwood Cir, Suite E, Maumelle, AR 72113-6327 | 2007-04-02 |
| 1427150036 | Salman F Hashmi | Family Medicine | 501 Millwood Cir, Suite E, Maumelle, AR 72113-6327 | 2006-09-03 |
| 1124037866 | Arkansas Health Group | Family Medicine | 1701 Club Manor Dr, Suite 2, Maumelle, AR 72113-7400 | 2006-08-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922609833 | Lafayette County Family Practice | Family Medicine | 226 Spruce Street, Lewisville, AR 71845 | 2020-11-06 |
| 1285234252 | Healthstar Physicians of Hot Springs, Pllc | Family Medicine | 220 Madison 2620, Kingston, AR 72742 | 2020-10-29 |
| 1932709995 | Healthstar Physicians of Hot Springs, Pllc | Family Medicine | 505 W Section Line Road, Poyen, AR 72128 | 2020-10-29 |
| 1124627781 | Healthstar Physicians of Hot Springs, Pllc | Family Medicine | 370 Highway 215, Oark, AR 72852-8858 | 2020-10-23 |
| 1932708641 | Premiere Family Practice | Family Medicine | 1904 Grant Ave Ste G, Jonesboro, AR 72401-6165 | 2020-10-22 |
| 1790383156 | Arkansas Health Group | Family Medicine | 4635 John F Kennedy Blvd, North Little Rock, AR 72116-7310 | 2020-10-16 |
| 1932707650 | Relymd Medical Group Ar, Pllc | Family Medicine | 1215 Twin Lakes Dr, Little Rock, AR 72205-6768 | 2020-10-14 |
| 1679180624 | Nwa Md Consulting Pllc | Family Medicine | 199 N 34th St, Rogers, AR 72756-0304 | 2020-09-24 |
| 1417563321 | Access Medical Clinic Arkansas LLC | Family Medicine | 444 Taylor Circle, Cave City, AR 72521 | 2020-09-17 |
| 1871107474 | Mimo Medical Services, LLC | Family Medicine | 2506 Crestview Dr, Magnolia, AR 71753-4336 | 2020-09-02 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.