Organization
WAGGENSPACK MEDICAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEREMY WAGGENSPACK M.D. (OWNER)
(504) 875-4029
Entity
Organization
Contact information
Practice address
6723 VICKSBURG ST, NEW ORLEANS, LA 70124-3321
(504) 875-4029
Mailing address
6723 VICKSBURG ST, NEW ORLEANS, LA 70124-3321
(504) 875-4029
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD203258
LA
208000000X
Pediatrics Physician
MD203258
LA
Other
Enumeration date
03/01/2010
Last updated
03/11/2011
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