Provider Demographics
NPI:1588647481
Name:WAGUESPACK, ROBERT L (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:WAGUESPACK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 406
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93302-0406
Mailing Address - Country:US
Mailing Address - Phone:661-331-3303
Mailing Address - Fax:661-321-3308
Practice Address - Street 1:3550 Q ST STE 302
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-1645
Practice Address - Country:US
Practice Address - Phone:661-331-3303
Practice Address - Fax:661-321-3308
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG84995208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G849950Medicaid
CA00G849950Medicaid