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Individual

DR. RICHARD LEE WIGLE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1501 KINGS HWY, SHREVEPORT, LA 71103-4228
(318) 675-5000
Mailing address
1512 W KIRBY PL, SHREVEPORT, LA 71103-3822
(318) 675-5177

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
025209
WA
208600000X
Surgery Physician
15769
SC
208600000X
Surgery Physician
25673
NC
208600000X
Surgery Physician
33847
MN
208600000X
Surgery Physician
9525
MS
208600000X
Surgery Physician
98-198
NM
208600000X
Surgery Physician
G1230
TX
208600000X
Surgery Physician
G28185
CA
208600000X
Surgery Physician
M7531
ID
2086S0127X
Trauma Surgery Physician
Primary
05539R
LA
2086S0127X
Trauma Surgery Physician
50898
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1032824
LA
01
4K995F600
MEDICARE - PTAN
LA
Enumeration date
07/27/2006
Last updated
07/30/2012
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