Provider Demographics
NPI:1306833819
Name:WIGGINS, CAROL JANE (MD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:JANE
Last Name:WIGGINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3260 PROVIDENCE DR
Mailing Address - Street 2:STE 322
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4608
Mailing Address - Country:US
Mailing Address - Phone:907-563-7228
Mailing Address - Fax:907-563-6278
Practice Address - Street 1:3260 PROVIDENCE DR
Practice Address - Street 2:SUITE 322
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508
Practice Address - Country:US
Practice Address - Phone:907-563-5151
Practice Address - Fax:907-562-6995
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA2469207V00000X
AK2469207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD24693Medicaid
AKMD24694Medicaid
AKMD24694Medicaid
AKD36033Medicare UPIN
AKMD24693Medicaid