Provider Demographics
NPI:1437126935
Name:WIGGIN, PETER AUSTIN (DPM)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:AUSTIN
Last Name:WIGGIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 WOOD ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44903-2211
Mailing Address - Country:US
Mailing Address - Phone:419-756-1875
Mailing Address - Fax:419-525-3264
Practice Address - Street 1:74 WOOD ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44903-2211
Practice Address - Country:US
Practice Address - Phone:419-756-1875
Practice Address - Fax:419-525-3264
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-02
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-002358W213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0634719Medicaid
OHWI0584531Medicare PIN
OH0634719Medicaid
OHT80714Medicare UPIN