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NPI Code Detail

MEDICARE: DR. JOSHUA SCOTT WIGLESWORTH M.D.

MEDICARE: DR. JOSHUA SCOTT WIGLESWORTH M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2208000000XPediatrics Physician44209KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
144209OTHERKYKENTUCKY MEDICAL LICENSE

General Provider Information

NPI Number : 1003060260
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOSHUA SCOTT WIGLESWORTH M.D.
Provider Business Mailing Address
First Line : 303 S 4TH ST
Second Line :
City : DANVILLE
State : KY
Zip : 40422-2091
Country : US
Telephone Number : 859-236-1080
Fax Number : 859-236-1862
Provider Business Practice Location Address
First Line : 303 S 4TH ST
Second Line :
City : DANVILLE
State : KY
Zip : 40422-2091
Country : US
Telephone Number : 859-236-1080
Fax Number : 859-236-1862
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/13/2008
Last Update Date : 03/07/2023

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