Individual
DR. DOUGLAS WISTER LIGON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4895 EAST MAIN ST, STE A, ERIN, TN 37061
(931) 289-2929
(931) 289-2930
Mailing address
PO BOX 268, ERIN, TN 37061-0268
(931) 289-2929
(931) 289-2930
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
MD6383
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3148023
—
TN
01
—
4113788
BCBS/TENNCARE SELECT
TN
01
—
810676663
TAX IDENTIFACTION
TN
01
—
MD0000006383
MEDICAL LICENSE NUMBER
TN
01
—
P00282547
RAILROAD MEDICARE
TN
Enumeration date
06/25/2006
Last updated
01/25/2017
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