T W Wagner INC

NPI #1720183031 in Manila, Arkansas

Provider Information

NPI Number: 1720183031
Entity Type: Organization
Organization Name: T W Wagner INC
Primary Specialty: Family Medicine
Enumeration Date: Sep 13, 2006
Last Updated: Jul 22, 2016

Practice Location

Address: 3644 W STATE HIGHWAY 18
City: Manila
State: Arkansas
ZIP Code: 72442-8049
Phone: (870) 561-3300

Authorized Official

Name: TOMMY W WAGNER JR., MD
Title: OWNER
Phone: (870) 561-3300

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Nurse Practitioner - Family — Family	363LF0000X
Family Medicine	207Q00000X	Primary

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