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Organization
MARK D. WIGOD, MD, PA
Active
Organization
MARK D. WIGOD, MD, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK DAVID WIGOD MD (PRESIDENT)
(208) 377-9515
Entity
Organization
Contact information
Practice address
3630 E LOUISE DR, MERIDIAN, ID 83642-7975
(208) 377-9515
Mailing address
3630 E LOUISE DR, MERIDIAN, ID 83642-7975
(208) 377-9515
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
M8189
ID
Other
Enumeration date
01/31/2008
Last updated
01/31/2008
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