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General NPI Number Information
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NPI Number | 1942307343
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Entity Type | Individual
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Provider Name | LARRY S WIGGINTON MD
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Gender | Male
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2211 MAYFAIR DRIVE SUITE 201
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City | OWENSBORO
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State | KY
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Zip | 42301-4569
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Country | US
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Telephone | 270-926-8222
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Fax | 270-685-5101
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Provider Business Mailing Address
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Address Line | 2211 MAYFAIR DRIVE SUITE 201
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City | OWENSBORO
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State | KY
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Zip | 42301-4569
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Country | US
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Telephone | 270-926-8222
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Fax | 270-685-5101
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 14856
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License Number State | KY
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