Individual
DR. ROGER BRUCE WIGTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5216 DAWES AVE, ALEXANDRIA, VA 22311-1404
(703) 931-4746
(703) 931-1794
Mailing address
5216 DAWES AVE, ALEXANDRIA, VA 22311-1404
(703) 931-4746
(703) 931-1794
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
0101029799
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0004
CAREFIRST BSBC
VI
05
—
006045201
—
VA
01
—
078284
ANTHEM BCBS
VA
Enumeration date
06/12/2006
Last updated
11/23/2009
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