Provider Demographics
NPI:1962539965
Name:WIGGINS, ROGER G (MD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:G
Last Name:WIGGINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1620 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4754
Mailing Address - Country:US
Mailing Address - Phone:505-982-4848
Mailing Address - Fax:505-984-1149
Practice Address - Street 1:1620 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4754
Practice Address - Country:US
Practice Address - Phone:505-982-4848
Practice Address - Fax:505-984-1149
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2012-10-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NM82-1482084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNMAAA22212Medicare PIN