Provider Demographics
NPI:1164512752
Name:WIGGINS, RICHARD HENRY III (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:HENRY
Last Name:WIGGINS
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:30 N 1900 E
Mailing Address - Street 2:#1A071; DEPARTMENT OF RADIOLOGY
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84132-2140
Mailing Address - Country:US
Mailing Address - Phone:801-581-4624
Mailing Address - Fax:801-585-7330
Practice Address - Street 1:30 N 1900 E
Practice Address - Street 2:#1A071; DEPARTMENT OF RADIOLOGY
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-2140
Practice Address - Country:US
Practice Address - Phone:801-581-4624
Practice Address - Fax:801-585-7330
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT370536-12052085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology