Healthcare Provider Details

I. General information

NPI: 1245765247
Provider Name (Legal Business Name): JOHN COLES WIGGINS III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2017
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EMERGENCY MEDICINE (DIVISION OF ULTRASOUND) 1250 E MARSHALL ST
RICHMOND VA
23298-5051
US

IV. Provider business mailing address

1250 E MARSHALL ST BOX 980401
RICHMOND VA
23298-5051
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-4860
  • Fax:
Mailing address:
  • Phone: 804-828-4860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number101266215
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: