Charles Wesley Wagner, MD

Primary specialty

Pediatric Surgery PhysicianTaxonomy code 2086S0120X

License

N-7036 Issued in AR

Practice address

12609 Saint Charles Blvd
Little Rock, AR 72211-2227

Phone

(501) 680-0738

NPI assigned

Oct 18, 2022

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1666051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666051200000",
    "number": "1003532268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CHILDRENS WAY",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722023500",
            "telephone_number": "501-364-1447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12609 SAINT CHARLES BLVD",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722112227",
            "telephone_number": "501-680-0738"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "CHARLES",
        "middle_name": "WESLEY",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-10-18",
        "last_updated": "2022-10-18",
        "certification_date": "2022-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0120X",
            "taxonomy_group": "",
            "desc": "Surgery, Pediatric Surgery",
            "state": "AR",
            "license": "N-7036",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GENERAL PRACTICE",
            "identifier": "N-7036",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "N-7036",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carol Lovelace Wadley, M.C.D., CCC-SLP
• Ashley Clinton Wadsworth
• Charmaine Lavonne Wafer
• Debbie Lynn Waggoner, PHARMD
• Benjamin Robert Wagner, MD
• Kendall Darren Wagner, M.D.
• Kristen Leigh Wagner, PA-C
• McKenna Marie Wagner, PT, DPT
• Megan Elizabeth Wagner
• Nicholas Mark Wagner, DPT

• Pediatric Surgery Physician in Little Rock, AR
• Providers in Little Rock, AR by specialty
• Pediatric Surgery Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.