MEDICARE: DR. JIBRI M 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	207V00000X	Obstetrics & Gynecology Physician	00025592	AL
2	207V00000X	Obstetrics & Gynecology Physician	ME125439	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477618122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JIBRI M WIGGINS MD

Provider Business Mailing Address
First Line	:	PO BOX 44008
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32231-4008
Country	:	US
Telephone Number	:	904-383-1000
Fax Number	:	904-383-1412

Provider Business Practice Location Address
First Line	:	15255 MAX LEGGETT PKWY
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-7273
Country	:	US
Telephone Number	:	904-383-1000
Fax Number	:	904-383-1412

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

Provider Enumeration Date	:	12/23/2006
Last Update Date	:	12/04/2015

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