Healthcare Provider Details

I. General information

NPI: 1205813110
Provider Name (Legal Business Name): RODNEY PHILLIP WIGLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1693 SW CHANDLER AVE SUITE 250
BEND OR
97702-3236
US

IV. Provider business mailing address

1693 SW CHANDLER AVE SUITE 250
BEND OR
97702-3236
US

V. Phone/Fax

Practice location:
  • Phone: 541-388-0673
  • Fax: 541-388-2619
Mailing address:
  • Phone: 541-388-0673
  • Fax: 541-388-2619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: