Organization
MARK D. WIGOD, MD, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK DAVID WIGOD MD (PRESIDENT)
(208) 377-9515
Entity
Organization
Contact information
Practice address
3630 E LOUISE DR, MERIDIAN, ID 83642-7975
(208) 377-9515
Mailing address
3630 E LOUISE DR, MERIDIAN, ID 83642-7975
(208) 377-9515
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
M8189
ID
Other
Enumeration date
01/31/2008
Last updated
01/31/2008
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