Healthcare Provider Details

I. General information

NPI: 1316913965
Provider Name (Legal Business Name): RICHARD WAYNE WAGUESPACK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 06/29/2023
Certification Date: 02/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 6TH AVE S
BIRMINGHAM AL
35233-2110
US

IV. Provider business mailing address

PO BOX 55310
BIRMINGHAM AL
35255-5310
US

V. Phone/Fax

Practice location:
  • Phone: 205-934-9999
  • Fax: 205-996-4039
Mailing address:
  • Phone: 205-731-9701
  • Fax: 205-933-9051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number9093
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: