MEDICARE: DR. TERRY STONE WIGGINS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	E2940	TX

General Provider Information

NPI Number	:	1164432621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERRY STONE WIGGINS MD

Provider Business Mailing Address
First Line	:	2765 BEE CAVES RD.
Second Line	:	SUITE 201
City	:	AUSTIN
State	:	TX
Zip	:	78746-5640
Country	:	US
Telephone Number	:	512-328-2752
Fax Number	:	512-328-2751

Provider Business Practice Location Address
First Line	:	2765 BEE CAVES RD
Second Line	:	SUITE 201
City	:	AUSTIN
State	:	TX
Zip	:	78746-5640
Country	:	US
Telephone Number	:	512-328-2752
Fax Number	:	512-328-2751

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	05/09/2012

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