Provider Demographics
NPI:1215994587
Name:WIGERT, ROBERT D (MD)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:D
Last Name:WIGERT
Suffix:
Gender:M
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:PO BOX 421
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0421
Mailing Address - Country:US
Mailing Address - Phone:509-624-0111
Mailing Address - Fax:509-227-7070
Practice Address - Street 1:546 N JEFFERSON LN
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-7104
Practice Address - Country:US
Practice Address - Phone:509-624-0111
Practice Address - Fax:509-227-7070
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00020931207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA126572OtherL & I
WA1002278Medicaid
WA1002278Medicaid
WA1002278Medicaid