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Individual
WALLACE S LIGGETT IV
Active
Individual
WALLACE S LIGGETT IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-01735
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0010-01735
LICENSE
NC
01
—
970023056
RR MEDICARE
SC
05
—
GM0561
—
SC
Enumeration date
03/24/2006
Last updated
06/20/2016
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