Waggenspack Medical Group, LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

MD203258 Issued in LA

Legal business name

WAGGENSPACK MEDICAL GROUP, LLC

Practice address

6723 Vicksburg St
New Orleans, LA 70124-3321

Phone

(504) 875-4029

NPI assigned

Mar 1, 2010

Last updated

Mar 11, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jeremy Waggenspack, M.D.NPI 1437342615

Title

Owner

Phone

(504) 875-4029

Specialties & licenses 2

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jeremy Louis Waggenspack, M.D.

  • Internal Medicine Physician
  • New Orleans, LA
  • NPI 1437342615
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1267401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1299801600000",
    "number": "1770806077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6723 VICKSBURG ST",
            "city": "NEW ORLEANS",
            "state": "LA",
            "postal_code": "701243321",
            "telephone_number": "504-875-4029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6723 VICKSBURG ST",
            "city": "NEW ORLEANS",
            "state": "LA",
            "postal_code": "701243321",
            "telephone_number": "504-875-4029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAGGENSPACK MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-01",
        "last_updated": "2011-03-11",
        "status": "A",
        "authorized_official_last_name": "WAGGENSPACK",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "504-875-4029",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "LA",
            "license": "MD203258",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "LA",
            "license": "MD203258",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sudhanva Upendra Wadgaonkar, MD
• Reena Divya Wadhwa
• Courtlin Wadleigh
• Lauren Brooke Wadlington, COTA
• Shirley M Wagers, MSW
• Jeremy Louis Waggenspack, M.D.
• Dane Wagner, MD
• Emily Freilich Wagner
• Frank Hall Wagner, M.D.
• Karenton Laneice Wagner

• Internal Medicine Physician in New Orleans, LA
• Providers in New Orleans, LA by specialty
• Internal Medicine Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.