Provider Demographics
NPI:1336132448
Name:SIGMON, WILMONT LUTHER (MD)
Entity Type:Individual
Prefix:
First Name:WILMONT
Middle Name:LUTHER
Last Name:SIGMON
Suffix:
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 1:3709 WESTRIDGE CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-3335
Mailing Address - Country:US
Mailing Address - Phone:252-443-2125
Mailing Address - Fax:252-937-2508
Practice Address - Street 1:3709 WESTRIDGE CIRCLE DR
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-3335
Practice Address - Country:US
Practice Address - Phone:252-443-2125
Practice Address - Fax:252-937-2508
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC98-00695207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1150LOtherNCBCBS
NC891150LMedicaid
NC1150LOtherNCBCBS