Individual
JONATHAN J WIGGENHORN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2700 N 140TH AVENUE, STE 107, GOODYEAR, AZ 85395
(623) 353-8770
(623) 353-8771
Mailing address
2700 N 140TH AVE STE 107, GOODYEAR, AZ 85395-2439
(623) 537-7085
(623) 535-8771
Taxonomy
Speciality
Code
Description
License number
State
207YS0123X
Facial Plastic Surgery Physician
Primary
4738
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
272504
—
AZ
Enumeration date
06/23/2006
Last updated
08/17/2020
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