Provider Demographics
NPI:1336590108
Name:WIGGIN, ROBERT REIFORT (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:REIFORT
Last Name:WIGGIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ZICHUAN
Other - Middle Name:
Other - Last Name:QU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:555 E CHEVES ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506-2617
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:536 W 4TH AVE
Practice Address - Street 2:
Practice Address - City:GARNETT
Practice Address - State:KS
Practice Address - Zip Code:66032-1355
Practice Address - Country:US
Practice Address - Phone:785-448-2674
Practice Address - Fax:785-448-3091
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-23
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0071748207Q00000X
SCLL39753207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine