Healthcare Provider Details

I. General information

NPI: 1114028701
Provider Name (Legal Business Name): WILLIAM C. WIGINGTON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 11/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2708 RIFE MEDICAL LN #300 SUITE 300
ROGERS AR
72758-1452
US

IV. Provider business mailing address

2708 RIFE MEDICAL LANE #300 SUITE 300
ROGERS AR
72758-1452
US

V. Phone/Fax

Practice location:
  • Phone: 479-338-3030
  • Fax: 479-338-3079
Mailing address:
  • Phone: 479-338-3030
  • Fax: 479-338-3079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberE-6743
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: