MEDICARE: MR. LARRY S WIGGINTON MD

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
1	207V00000X	Obstetrics & Gynecology Physician	14856	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942307343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LARRY S WIGGINTON MD

Provider Business Mailing Address
First Line	:	2211 MAYFAIR DRIVE
Second Line	:	SUITE 201
City	:	OWENSBORO
State	:	KY
Zip	:	42301-4569
Country	:	US
Telephone Number	:	270-926-8222
Fax Number	:	270-685-5101

Provider Business Practice Location Address
First Line	:	2211 MAYFAIR DRIVE
Second Line	:	SUITE 201
City	:	OWENSBORO
State	:	KY
Zip	:	42301-4569
Country	:	US
Telephone Number	:	270-926-8222
Fax Number	:	270-685-5101

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/08/2007

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Directions to “ MR. LARRY S WIGGINTON MD” Practice Location

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