Provider Demographics
NPI:1275775165
Name:WAGUESPACK, CHRISTOPHER JOSEPH (DO)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:JOSEPH
Last Name:WAGUESPACK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11123 CHANTILLY PKWY CT
Mailing Address - Street 2:SUITE M
Mailing Address - City:PIKE ROAD
Mailing Address - State:AL
Mailing Address - Zip Code:36064-2880
Mailing Address - Country:US
Mailing Address - Phone:334-832-2301
Mailing Address - Fax:
Practice Address - Street 1:11123 CHANTILLY PKWY CT
Practice Address - Street 2:SUITE M
Practice Address - City:PIKE ROAD
Practice Address - State:AL
Practice Address - Zip Code:36064-2880
Practice Address - Country:US
Practice Address - Phone:334-832-2301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-24
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.122210207Q00000X
VA0102202301207Q00000X
ALDO1346207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine