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General NPI Number Information
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NPI Number | 1720013816
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Entity Type | Individual
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Provider Name | JAMES ROGER WADDILL M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 12/07/2007
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Provider Practice Location Address
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Address Line | 3401 NORTH BLVD
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City | BATON ROUGE
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State | LA
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Zip | 70806-3743
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Country | US
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Telephone | 225-336-3100
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Fax | 225-336-3111
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Provider Business Mailing Address
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Address Line | 9001 SUMMA AVE
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City | BATON ROUGE
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State | LA
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Zip | 70809-3726
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Country | US
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Telephone | 225-761-5200
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 17202
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License Number State | LA
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