MEDICARE: GENE MARTIN WIGGS II DO

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	2084P0800X	Psychiatry Physician	OS17740	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
2	IDDWQ	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1912569187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GENE MARTIN WIGGS II DO

Provider Business Mailing Address
First Line	:	PO BOX 917770
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32891-0001
Country	:	US
Telephone Number	:	813-821-8038
Fax Number	:

Provider Business Practice Location Address
First Line	:	304 E PINE ST # 5280
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33801-4969
Country	:	US
Telephone Number	:	863-248-2300
Fax Number	:

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

Provider Enumeration Date	:	07/08/2019
Last Update Date	:	12/07/2025

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