Provider Demographics
NPI:1598796799
Name:ROBERT L WAGUESPACK MD, APC
Entity Type:Organization
Organization Name:ROBERT L WAGUESPACK MD, APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:WAGUESPACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-321-3303
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:661-321-3303
Mailing Address - Fax:661-321-3308
Practice Address - Street 1:2530 F ST
Practice Address - Street 2:SUITE 101
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-3843
Practice Address - Country:US
Practice Address - Phone:661-321-3303
Practice Address - Fax:661-321-3308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G849950Medicaid
CA00G849950Medicare PIN