Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | OR |
NPI | 1205813110 |
---|---|
Provider Name | Dr. Rodney Phillip Wigle |
First Address | Bend, OR 97702-3236 |
Second Address | Bend, OR 97702-3236 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C94073 | (02) | OR |