Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 34447 | WI |
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 34447 | WI |
NPI | 1194777672 |
---|---|
Provider Name | Dr. Thomas Richard Wigton |
First Address | West Allis, WI 53227-2468 |
Second Address | West Allis, WI 53227-2468 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 24/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002000138N | HUMANA (01) | |
31944700 | (05) | WI |
F58369 | (02) |