Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213EP1101X | Primary Podiatric Medicine | PO3625 | FL |
Y | 213ES0103X | Foot & Ankle Surgery | PO3625 | FL |
NPI | 1184913097 |
---|---|
Provider Name | Dr. Stephen Wigley IV |
First Address | North Miami Beach, FL 33162-4717 |
Second Address | North Miami Beach, FL 33162-4717 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2011 |
Last Update Date | 13/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010794200 | (05) | FL |