# DANIEL LEE WAGSTAFF

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

## Provider details

- **NPI number:** 1417904442
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 203440 | LA | — |
| 207R00000X | Internal Medicine Physician | 24395 | SC | Yes |
| 208M00000X | Hospitalist Physician | 203440 | LA | — |

## Other

- **Enumeration date:** 05/27/2006
- **Last updated:** 02/12/2016

## 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 |