Provider Demographics
NPI:1164478897
Name:WIGGINS, JAMES WISE JR (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:WISE
Last Name:WIGGINS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1232 N 30TH ST
Mailing Address - Street 2:#300
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-0139
Mailing Address - Country:US
Mailing Address - Phone:406-238-6190
Mailing Address - Fax:406-238-6199
Practice Address - Street 1:1232 N 30TH
Practice Address - Street 2:#300
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101
Practice Address - Country:US
Practice Address - Phone:406-238-6190
Practice Address - Fax:406-238-6199
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MT51092080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0100215Medicaid
MT010001422Medicare ID - Type Unspecified
D60805Medicare UPIN