Provider Demographics
NPI:1992763254
Name:WIGGINS, JOSEPH D (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:D
Last Name:WIGGINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:657 LONE OAK ROAD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-4547
Mailing Address - Country:US
Mailing Address - Phone:270-443-4430
Mailing Address - Fax:270-443-4462
Practice Address - Street 1:657 LONE OAK ROAD
Practice Address - Street 2:SUITE 1
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-4547
Practice Address - Country:US
Practice Address - Phone:270-443-4430
Practice Address - Fax:270-443-4462
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY20954207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64209547Medicaid
KY000000047719OtherBCBS
C68268Medicare UPIN
KY1347801Medicare PIN