Organization
ROLAND S. WAGUESPACK MD APMC
Active
Other names
ST. PHILIP CLINIC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROLAND S. WAGUESPACK M.D. (M.D.)
(225) 265-4087
Entity
Organization
Contact information
Practice address
1108 SAINT JAMES ST, VACHERIE, LA 70090-5320
(225) 265-4087
(225) 265-4006
Mailing address
1108 SAINT JAMES STREET, VACHERIE, LA 70090
(225) 265-4087
(225) 265-4006
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
23919
LA
261QP2300X
Primary Care Clinic/Center
Primary
009974
LA
261QP2300X
Primary Care Clinic/Center
203080
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1442224
—
LA
Enumeration date
12/19/2006
Last updated
01/19/2010
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