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Individual
DANIEL LEE WAGSTAFF
Active
Individual
DANIEL LEE WAGSTAFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
203440
LA
207R00000X
Internal Medicine Physician
Primary
24395
SC
208M00000X
Hospitalist Physician
203440
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03427237
—
MS
05
—
1808580
—
LA
05
—
243953
—
SC
01
—
5135341
CIGNA ID
SC
01
—
576007863071
BLUECHOICE HEALTHPLAN ID
SC
01
—
576007863095
BCBS OF SC ID
SC
01
—
7712588
AETNA ID
SC
01
—
P00110891
RR MEDICARE
SC
01
—
P01577390
RAILROAD MEDICARE
SC
Enumeration date
05/27/2006
Last updated
02/12/2016
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