Provider Demographics
NPI:1447238936
Name:WIGGINS, JAMES J (D O)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:J
Last Name:WIGGINS
Suffix:
Gender:M
Credentials:D O
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:J
Other - Last Name:WIGGINS, D.O., INC.
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:275 W HERNDON AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-0204
Mailing Address - Country:US
Mailing Address - Phone:559-324-6200
Mailing Address - Fax:559-324-6280
Practice Address - Street 1:275 W HERNDON AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-0204
Practice Address - Country:US
Practice Address - Phone:559-624-6200
Practice Address - Fax:559-324-6280
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6833207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX68331Medicaid
CA020A68330Medicare ID - Type Unspecified
CA00AX68331Medicaid