Provider Demographics
NPI:1710983291
Name:WAGMAN, ARMIN JARED (MD)
Entity Type:Individual
Prefix:DR
First Name:ARMIN
Middle Name:JARED
Last Name:WAGMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 CONCORD TER
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2843
Mailing Address - Country:US
Mailing Address - Phone:800-243-3839
Mailing Address - Fax:
Practice Address - Street 1:4350 S NATIONAL AVE
Practice Address - Street 2:# C-100
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65810-2607
Practice Address - Country:US
Practice Address - Phone:417-447-4700
Practice Address - Fax:417-447-4701
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3P312080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203144100Medicaid
AR150780001Medicaid
KS20000020 AMedicaid
OK100006210AMedicaid
KS20000020 AMedicaid