Provider Demographics
NPI:1629084975
Name:WIGGINS, JON (MD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:
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 1:33663 BAYVIEW MEDICAL DR
Mailing Address - Street 2:UNIT 2
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-1663
Mailing Address - Country:US
Mailing Address - Phone:302-645-9325
Mailing Address - Fax:302-645-5214
Practice Address - Street 1:33663 BAYVIEW MEDICAL DR
Practice Address - Street 2:UNIT 2
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-1663
Practice Address - Country:US
Practice Address - Phone:302-645-9325
Practice Address - Fax:302-645-5214
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236326207R00000X
DEC10009383207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology