Individual
KEITH A WAGUESPACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2021 N MACARTHUR BLVD STE 450, IRVING, TX 75061
(866) 367-8768
(817) 541-9301
Mailing address
5001 S COOPER ST STE 201, ARLINGTON, TX 76017-5993
(866) 367-8768
(817) 541-9555
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
L7918
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
165039201
—
TX
05
—
165039202
—
TX
05
—
165039203
—
TX
05
—
165039204
—
TX
05
—
165039205
—
TX
Enumeration date
09/20/2005
Last updated
07/17/2019
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