Provider Demographics
NPI:1689238693
Name:WIGGINS, BRANDON TRAVIS (DO, MPH)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:TRAVIS
Last Name:WIGGINS
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Gender:M
Credentials:DO, MPH
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Mailing Address - Street 1:1 GENESYS PKWY
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-8065
Mailing Address - Country:US
Mailing Address - Phone:810-606-5986
Mailing Address - Fax:810-606-5636
Practice Address - Street 1:1 GENESYS PKWY
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-8065
Practice Address - Country:US
Practice Address - Phone:810-606-5986
Practice Address - Fax:810-606-5636
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-24
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101027566207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology