Provider Demographics
NPI:1952372567
Name:WIGGINS, HORACE LYNN JR (MD)
Entity type:Individual
Prefix:MR
First Name:HORACE
Middle Name:LYNN
Last Name:WIGGINS
Suffix:JR
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 1:1005 E MATTHEWS AVE
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-4308
Mailing Address - Country:US
Mailing Address - Phone:870-935-1242
Mailing Address - Fax:870-336-1355
Practice Address - Street 1:1005 E MATTHEWS AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4308
Practice Address - Country:US
Practice Address - Phone:870-935-1242
Practice Address - Fax:870-336-1355
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR3455208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
D83899Medicare UPIN
55671Medicare ID - Type Unspecified