Provider Demographics
NPI:1336590108
Name:WIGGIN, ROBERT REIFORT (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:REIFORT
Last Name:WIGGIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ZICHUAN
Other - Middle Name:
Other - Last Name:QU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:255 S ROUTT ST STE 300
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-2354
Mailing Address - Country:US
Mailing Address - Phone:720-321-8280
Mailing Address - Fax:720-321-8281
Practice Address - Street 1:255 S ROUTT ST STE 300
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-2354
Practice Address - Country:US
Practice Address - Phone:720-321-8280
Practice Address - Fax:720-321-8281
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-23
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL39753207Q00000X
CODR.0071748207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000227169Medicaid