Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | MD00035873 | WA |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | MD00035873 | WA |
NPI | 1942202635 |
---|---|
Provider Name | Dr. Terry Lee Wigley |
First Address | Richland, WA 99352-9532 |
Second Address | Pasco, WA 99301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2005 |
Last Update Date | 05/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2041577 | (05) | WA |
F12630 | (02) | OR |