Provider Demographics
NPI:1437131604
Name:WIGGINS, STANLEY L (MD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:L
Last Name:WIGGINS
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 1:12730 NEW BRITTANY BLVD STE 602
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-4690
Mailing Address - Country:US
Mailing Address - Phone:239-275-5522
Mailing Address - Fax:239-275-4464
Practice Address - Street 1:1261 VISCAYA PKWY STE 101
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3252
Practice Address - Country:US
Practice Address - Phone:239-573-7337
Practice Address - Fax:239-574-5883
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91060208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL48377OtherBC/BS OF FLORIDA
FL000013683BOtherHUMANA
FL270355600Medicaid
FL294917OtherAVMED
FL272228OtherSTAYWELL
FLI16782Medicare UPIN
FL48377ZMedicare ID - Type Unspecified