Provider Demographics
NPI:1184716144
Name:WIGGINS, ROBERT VERNE
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:VERNE
Last Name:WIGGINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 SE BISHOP BLVD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-5517
Mailing Address - Country:US
Mailing Address - Phone:509-334-5876
Mailing Address - Fax:509-332-8793
Practice Address - Street 1:825 SE BISHOP BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-5517
Practice Address - Country:US
Practice Address - Phone:509-334-5876
Practice Address - Fax:509-332-8793
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00025460207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
911408453OtherPREMERA BLUE CROSS
ID003289500Medicaid
IDDEHV6OtherBLUE CROSS OF ID
0007539OtherLABOR AND INDUSTRIES
WA1046598Medicaid
WA911408453OtherGROUP HEALTH
WA911408453OtherMOLINA HEALTHCARE
WA8912267OtherCVCP
ID000010004066OtherBLUE SHIELD OF ID
WA911408453OtherFIRST CHOICE
911408453OtherUNITED HEALTHCARE
0007539OtherLABOR AND INDUSTRIES
WAD65706Medicare UPIN
040002263Medicare ID - Type Unspecified
ID003289500Medicaid