Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | 5109 | MT |
NPI | 1164478897 |
---|---|
Provider Name | James Wise Wiggins JR. |
First Address | Billings, MT 59101-0139 |
Second Address | Billings, MT 59101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2006 |
Last Update Date | 10/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0100215 | (05) | MT |
D60805 | (02) |