# DR. WAME NICHOLAS WAGGENSPACK JR.

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1003834169
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207P00000X | Emergency Medicine Physician | 19439 | MS | — |
| 207P00000X | Emergency Medicine Physician | 201531 | LA | — |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | 19439 | MS | — |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | 201531 | LA | — |
| 207X00000X | Orthopaedic Surgery Physician | 201531 | LA | Yes |
| 207X00000X | Orthopaedic Surgery Physician | L9952 | TX | — |

## Other

- **Enumeration date:** 07/17/2006
- **Last updated:** 02/26/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 04476300 | — | MS |
| 05 | — | 1018236 | — | LA |