Individual
MR. ROLAND S WAGUESPACK JR.
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1108 ST JAMES ST, VACHERIE, LA 70090
(225) 265-4087
(225) 265-4678
Mailing address
1108 ST JAMES ST, VACHERIE, LA 70090
(225) 265-4087
(225) 265-4678
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
009974
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1090123
—
LA
Enumeration date
02/27/2006
Last updated
07/08/2007
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