Individual
DR. MARK DAVID WIGOD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3630 E LOUISE DRIVE, MERIDIAN, ID 83642
(208) 377-9515
(208) 377-9517
Mailing address
7157 N SPURWING WAY, MERIDIAN, ID 83642-5179
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
M8189
ID
Other
Enumeration date
06/29/2006
Last updated
07/08/2007
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