Most Relevant Information
Provider Data
| NPI Number: | 1003532268 |
| Provider Name: | CHARLES WESLEY WAGNER MD |
| Entity Type: | Individual |
| Taxonomy Code: | 2086S0120X |
| Specialty: | Surgery |
| License Number: | N-7036 |
Most Important Dates
| Enumeration Date: | 10/18/2022 |
| Last Updated: | 10/18/2022 |
Provider Practice Location
12609 SAINT CHARLES BLVD
LITTLE ROCK
AR
722112227
Practice Location Phone/Fax
| Phone: | 5016800738 |
| Fax: |
Provider Mailing Location
1 CHILDRENS WAY
LITTLE ROCK
AR
722023500
Provider Mailing Phone/Fax
| Phone: | 5013641447 |
| Fax: |