MEDICARE: DAVID D WADDELL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	MD.012603	LA

General Provider Information

NPI Number	:	1598758849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID D WADDELL MD

Provider Business Mailing Address
First Line	:	6999 BICKHAM RD
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71107-8398
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6999 BICKHAM RD
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71107-8398
Country	:	US
Telephone Number	:	318-929-2900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	11/29/2017

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