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General NPI Number Information
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NPI Number | 1386456267
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Entity Type | Organization
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Legal Business Name | WIG DOCTOR RX INC.
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Dates
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Enumeration Date | 01/27/2025
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 1839 LANE AVE S STE 101
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City | JACKSONVILLE
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State | FL
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Zip | 32210-1260
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Country | US
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Telephone | 904-775-3071
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Fax |
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Provider Business Mailing Address
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Address Line | 2600 ART MUSEUM DR APT 176
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City | JACKSONVILLE
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State | FL
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Zip | 32207-4849
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Country | US
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Telephone | 904-430-2420
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RANDE HARRIS
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Credential |
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Telephone | 904-430-2420
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224P00000X
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Taxonomy Name | Prosthetist
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License Number |
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License Number State |
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