Healthcare Provider Details

I. General information

NPI: 1063402717
Provider Name (Legal Business Name): SHERMAN S WIGGINS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 12/09/2021
Certification Date: 12/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1453 E BERT KOUN LOOP STE 112
SHREVEPORT LA
71105-6810
US

IV. Provider business mailing address

PO BOX 51008
SHREVEPORT LA
71135-1008
US

V. Phone/Fax

Practice location:
  • Phone: 318-798-9400
  • Fax: 318-795-4656
Mailing address:
  • Phone: 318-798-9400
  • Fax: 318-798-3894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD.018997
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberMD.018997
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: