MEDICARE: MR. ROBERT D WIGERT 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	207R00000X	Internal Medicine Physician	MD00020931	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	126572	OTHER	WA	L & I
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215994587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT D WIGERT MD

Provider Business Mailing Address
First Line	:	PO BOX 421
Second Line	:
City	:	LIBERTY LAKE
State	:	WA
Zip	:	99019-0421
Country	:	US
Telephone Number	:	509-624-0111
Fax Number	:	509-227-7070

Provider Business Practice Location Address
First Line	:	546 N JEFFERSON LN
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99201-7104
Country	:	US
Telephone Number	:	509-624-0111
Fax Number	:	509-227-7070

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

Provider Enumeration Date	:	04/28/2006
Last Update Date	:	04/29/2021

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