Basic Information
Provider Information | |||||||||
NPI: | 1447238936 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | WIGGINS | ||||||||
FirstName: | JAMES | ||||||||
MiddleName: | J | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | D. O. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | WIGGINS, D.O., INC. | ||||||||
OtherFirstName: | JAMES | ||||||||
OtherMiddleName: | J. | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | D.O. | ||||||||
OtherLastNameType: | 2 | ||||||||
Mailing Information | |||||||||
Address1: | 275 W HERNDON AVE | ||||||||
Address2: |   | ||||||||
City: | CLOVIS | ||||||||
State: | CA | ||||||||
PostalCode: | 936120204 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5593246200 | ||||||||
FaxNumber: | 5593246280 | ||||||||
Practice Location | |||||||||
Address1: | 275 W HERNDON AVE | ||||||||
Address2: |   | ||||||||
City: | CLOVIS | ||||||||
State: | CA | ||||||||
PostalCode: | 936120204 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5596246200 | ||||||||
FaxNumber: | 5593246280 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/04/2006 | ||||||||
LastUpdateDate: | 06/08/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 20A6833 | CA | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 00AX68331 | 05 | CA |   | MEDICAID |