Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Matthew Wagoner

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1184372104

Matthew Wagoner is a Student in an Organized Health Care Education/Training Program in Saint Louis, Missouri. Practices as a sole proprietor. Licensed in Missouri.

Licensed in
MO
In the registry since
2022

Practice location Address checks out

1402 S Grand Blvd
Saint Louis, MO 63104-1004
Phone: (314) 605-1445
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Student in an Organized Health Care Education/Training Program (primary) Taxonomy 390200000X (MO)

Record details

NPI number1184372104
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedMarch 17, 2022
Last updated in NPPESMarch 17, 2022
Certification dateMarch 16, 2022

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