Waggenspack Medical Group, Llc | |
6723 Vicksburg St New Orleans LA 70124-3321 | |
(504) 875-4029 | |
Not Available |
Full Name | Waggenspack Medical Group, Llc |
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Speciality | Internal Medicine |
Location | 6723 Vicksburg St, New Orleans, Louisiana |
Authorized Official Name and Position | Jeremy Waggenspack (OWNER) |
Authorized Official Contact | 5048754029 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Waggenspack Medical Group, Llc 6723 Vicksburg St New Orleans LA 70124-3321 Ph: (504) 875-4029 | Waggenspack Medical Group, Llc 6723 Vicksburg St New Orleans LA 70124-3321 Ph: (504) 875-4029 |
NPI Number | 1770806077 |
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Provider Enumeration Date | 03/01/2010 |
Last Update Date | 03/11/2011 |
Identifier | Type | State | Issuer |
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1770806077 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | MD203258 (Louisiana) | Primary |
208000000X | Pediatrics | MD203258 (Louisiana) | Secondary |
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