Provider Demographics
NPI:1396926424
Name:WIGTON, ERIC HUNT (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:HUNT
Last Name:WIGTON
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 1:3990 N ILLINOIS ST
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-1919
Mailing Address - Country:US
Mailing Address - Phone:618-277-1130
Mailing Address - Fax:618-277-4917
Practice Address - Street 1:3990 N ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-1919
Practice Address - Country:US
Practice Address - Phone:618-277-1130
Practice Address - Fax:618-277-4917
Is Sole Proprietor?:No
Enumeration Date:2007-11-16
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL29048207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051117260OtherBCBS
AL128667Medicaid
AL051117254OtherBCBS
AL128661Medicaid
AL051117258OtherBCBS
MS07805726Medicaid
AL128645Medicaid
AL051117262OtherBCBS
AL051117253OtherBCBS
AL051117259OtherBCBS
AL128646Medicaid
AL128662Medicaid
AL128660Medicaid
AL102I500465Medicare PIN