Individual
JEREMY WIGGINTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2750 GAUSE BLVD E, SLIDELL, LA 70461-4149
(985) 639-3777
Mailing address
1514 JEFFERSON HWY, NEW ORLEANS, LA 70121-2429
(504) 842-4000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD.207287
LA
207Q00000X
Family Medicine Physician
T-2259
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07352760
—
MS
05
—
2377850
—
LA
Enumeration date
07/06/2009
Last updated
04/24/2015
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