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General NPI Number Information
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NPI Number | 1003834169
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Entity Type | Individual
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Provider Name | WAME NICHOLAS WAGGENSPACK JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 02/26/2025
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Provider Practice Location Address
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Address Line | 8080 BLUEBONNET BLVD SUITE 1000
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City | BATON ROUGE
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State | LA
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Zip | 70810-7827
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Country | US
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Telephone | 225-924-2424
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Fax | 225-408-7984
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Provider Business Mailing Address
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Address Line | 8080 BLUEBONNET BLVD SUITE 1000
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City | BATON ROUGE
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State | LA
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Zip | 70810-7827
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Country | US
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Telephone | 225-924-2424
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Fax | 225-408-7984
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 201531
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 19439
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 19439
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License Number State | MS
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Taxonomy #4
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 201531
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License Number State | LA
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Taxonomy #5
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | L9952
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License Number State | TX
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Taxonomy #6
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 201531
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License Number State | LA
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