Healthcare Provider Details

I. General information

NPI: 1437126935
Provider Name (Legal Business Name): PETER AUSTIN WIGGIN D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 03/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 WOOD ST
MANSFIELD OH
44903-2211
US

IV. Provider business mailing address

74 WOOD ST
MANSFIELD OH
44903-2211
US

V. Phone/Fax

Practice location:
  • Phone: 419-756-1875
  • Fax: 419-525-3264
Mailing address:
  • Phone: 419-756-1875
  • Fax: 419-525-3264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number36-002358W
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: