Individual
ERIC WAETJEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1747 IMPERIAL BLVD, LAKE CHARLES, LA 70605-5362
(337) 721-7236
(337) 721-7237
Mailing address
1747 IMPERIAL BLVD, LAKE CHARLES, LA 70605-5362
(337) 721-7236
(337) 721-7237
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
2016020253
MO
208600000X
Surgery Physician
Primary
342862
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2016020253
MI
MO
Enumeration date
06/23/2016
Last updated
08/02/2024
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