Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | MD.018997 | LA |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | MD.018997 | LA |
NPI | 1063402717 |
---|---|
Provider Name | Dr. Sherman S Wiggins |
First Address | Shreveport, LA 71135-1008 |
Second Address | Shreveport, LA 71105-6810 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2005 |
Last Update Date | 09/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
060021052 | RAILROAD MEDICARE (01) | LA |
107224101 | (05) | TX |
127235001 | (05) | AR |
1973807 | (05) | LA |
C74342 | (02) | LA |