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General NPI Number Information
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NPI Number | 1457388035
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Entity Type | Individual
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Provider Name | ALEXIS M WAGUESPACK M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/27/2006
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Last Update Date | 02/07/2024
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Provider Practice Location Address
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Address Line | 3939 HOUMA BLVD STE 18
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City | METAIRIE
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State | LA
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Zip | 70006-2921
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Country | US
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Telephone | 504-392-7123
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Fax | 504-392-7823
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Provider Business Mailing Address
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Address Line | 3939 HOUMA BLVD STE 18
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City | METAIRIE
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State | LA
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Zip | 70006-2921
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Country | US
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Telephone | 504-392-7123
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Fax | 504-392-7823
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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 | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | MD.09377R
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License Number State | LA
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