Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 19439 | MS |
N | 207P00000X | Emergency Physician | 201531 | LA |
N | 207QS0010X | Family Doctor - Sports Medicine | 19439 | MS |
N | 207QS0010X | Family Doctor - Sports Medicine | 201531 | LA |
Y | 207X00000X | Orthopaedic Surgeon | 201531 | LA |
NPI | 1003834169 |
---|---|
Provider Name | Dr. Wame Nicholas Waggenspack JR. |
First Address | Baton Rouge, LA 70810-7827 |
Second Address | Baton Rouge, LA 70810-7827 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 21/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
04476300 | (05) | MS |
1018236 | (05) | LA |
I65395 | (02) |