Provider Demographics
NPI:1831364892
Name:TERRY S WIGGINS MD PA
Entity type:Organization
Organization Name:TERRY S WIGGINS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHORTINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-784-0997
Mailing Address - Street 1:2765 BEE CAVES RD STE 201
Mailing Address - Street 2:SUITE 201
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5640
Mailing Address - Country:US
Mailing Address - Phone:512-328-2752
Mailing Address - Fax:512-328-2751
Practice Address - Street 1:2712 BEECAVE RD
Practice Address - Street 2:SUITE 122
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-5662
Practice Address - Country:US
Practice Address - Phone:512-328-2752
Practice Address - Fax:512-328-2751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE2940207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00236UMedicare PIN
TXB27569Medicare UPIN