Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 100610 | MO |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 100610 | MO |
NPI | 1194826164 |
---|---|
Provider Name | Dr. Stanley D. Wiggins |
First Address | Saint Louis, MO 63150-5164 |
Second Address | Springfield, MO 65804-2239 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 26/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
203371612 | (05) | MO |
B27571 | (02) | MO |