Provider Demographics
NPI:1912569187
Name:WIGGS, GENE MARTIN II (DO)
Entity type:Individual
Prefix:
First Name:GENE
Middle Name:MARTIN
Last Name:WIGGS
Suffix:II
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:MARTY
Other - Middle Name:
Other - Last Name:WIGGS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:304 E PINE ST # 5280
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-4969
Mailing Address - Country:US
Mailing Address - Phone:863-248-2300
Mailing Address - Fax:
Practice Address - Street 1:304 E PINE ST # 5280
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-4969
Practice Address - Country:US
Practice Address - Phone:863-248-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-08
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS177402084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry