Healthcare Provider Details

I. General information

NPI: 1184716144
Provider Name (Legal Business Name): DR. ROBERT VERNE WIGGINS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 SE BISHOP BLVD SUITE 130
PULLMAN WA
99163-5517
US

IV. Provider business mailing address

825 SE BISHOP BLVD SUITE 130
PULLMAN WA
99163-5517
US

V. Phone/Fax

Practice location:
  • Phone: 509-334-5876
  • Fax: 509-332-8793
Mailing address:
  • Phone: 509-334-5876
  • Fax: 509-332-8793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License NumberMD00025460
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: