Individual
KENNON D WIGLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2700 E 29TH STREET, SUITE 220, BRYAN, TX 77802
(979) 774-4008
(979) 774-7893
Mailing address
2700 E 29TH STREET, SUITE 220, BRYAN, TX 77802
(979) 774-4008
(979) 774-7893
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
G5771
TX
Other
Enumeration date
03/07/2006
Last updated
06/13/2011
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