Provider Demographics
NPI:1083928790
Name:WIGGINS, CLIFFORD MILTON (LMT)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:MILTON
Last Name:WIGGINS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 NW 14TH PL
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34428-3872
Mailing Address - Country:US
Mailing Address - Phone:352-586-5407
Mailing Address - Fax:
Practice Address - Street 1:560 NW 14TH PL
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34428-3872
Practice Address - Country:US
Practice Address - Phone:352-586-5407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist