NPI 1992021190

Michael Waggoner OD PA

Organisation Health Maintenance Organization Fayetteville, AR

Practice location

Address: 2630 E Citizens Dr STE 6, Fayetteville, AR 72703-4797
Phone: (479) 582-1212
Fax: (479) 582-2070

Authorised official

Name: Michael Waggoner
Title: Owner
Phone: (479) 582-1212

Registered specialties

Health Maintenance Organization Primary

Managed Care Organizations Taxonomy 302R00000X Licence 2411 (AR)

Other Health Maintenance Organization providers in Arkansas →

Registry record

NPI: 1992021190
Entity type: Organization
NPI issued: 13 Apr 2010
Record last updated: 12 Aug 2015

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.