Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 44209 | KY |
NPI | 1003060260 |
---|---|
Provider Name | Dr. Joshua Scott Wiglesworth |
First Address | Danville, KY 40422-2091 |
Second Address | Danville, KY 40422-2091 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2008 |
Last Update Date | 22/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
44209 | KENTUCKY MEDICAL LICENSE (01) | KY |
FW1497278 | DEA (01) |