Provider Demographics
NPI:1154421485
Name:MACKAY-WIGGAN, JULIAN (MD)
Entity type:Individual
Prefix:DR
First Name:JULIAN
Middle Name:
Last Name:MACKAY-WIGGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9897 HAGEN RANCH RD
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33472-7400
Mailing Address - Country:US
Mailing Address - Phone:561-364-7774
Mailing Address - Fax:561-364-7775
Practice Address - Street 1:9897 HAGEN RANCH RD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33472-7400
Practice Address - Country:US
Practice Address - Phone:561-364-7774
Practice Address - Fax:561-364-7775
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY224157-1207N00000X
FLME132842207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02329555Medicaid
NYH62529Medicare UPIN
NY9J2081Medicare ID - Type Unspecified