Individual
DR. CLARK DAVID WIGINTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
BP1-0022835
TX
2085R0202X
Diagnostic Radiology Physician
Primary
M8427
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
202920903
—
TX
01
—
2776501934
MYUTMB 2776501934-COMMERCIAL NUMBER
—
Enumeration date
06/14/2007
Last updated
03/04/2011
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