Individual provider Active NPI

Gene Martin Wiggs II, DO

  • Psychiatry Physician
  • Lakeland, FL
National Provider Identifier
1912569187
Registry record updated Dec 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
OS17740 Issued in FL
Practice address
304 E Pine St # 5280
Lakeland, FL 33801-4969
Phone
(863) 248-2300
NPI assigned
Jul 8, 2019
Last updated
Dec 7, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X OS17740 FL Primary

Addresses

Primary practice location

304 E Pine St # 5280
Lakeland, FL 33801-4969

Mailing address

PO Box 917770
Orlando, FL 32891-0001
Phone (813) 821-8038

Other practice location 1

1303 W Kennedy Blvd
Tampa, FL 33606-1848
Phone (813) 893-6330

Other identifiers 2

IdentifierTypeStateIssuer
IDDWQOtherFLBCBS
114116100MedicaidFL

Other names 1

  • Marty Wiggs Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address gwiggs353432@direct.tgh.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230728003007 FL Practitioner - Psychiatry 8921469529 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Tampa General Hospital Current Accepting new patients
University Medical Service Association Inc CurrentSince May 1, 2025 Accepting new patients
University Medical Service Association Inc Psychiatry CurrentSince May 1, 2025 Accepting new patients
University Medical Service Association Inc Current Accepting new patients
Centerstone of Florida, Inc. PastSince Jul 26, 1995 Accepting new patients

Locations

12901 Bruce B Downs Blvd
#62
Tampa, FL 33612

4202 E Fowler Ave
Stop SHS100
Tampa, FL 33620
Phone (813) 974-2331

Interoperability endpoints

  • Direct secure messaging: gwiggs353432@direct.tgh.org
  • FHIR API: https://epicproxy.et0761.epichosted.com/FHIRProxy/api/FHIR/R4/

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1562544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765065600000",
    "number": "1912569187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 917770",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328910001",
            "telephone_number": "813-821-8038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "304 E PINE ST # 5280",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338014969",
            "telephone_number": "863-248-2300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1303 W Kennedy Blvd",
            "address_purpose": "LOCATION",
            "city": "Tampa",
            "state": "FL",
            "postal_code": "336061848",
            "country_code": "US",
            "telephone_number": "813-893-6330",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WIGGS",
        "first_name": "GENE",
        "middle_name": "MARTIN",
        "name_suffix": "II",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-07-08",
        "last_updated": "2025-12-07",
        "certification_date": "2025-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "FL",
            "license": "OS17740",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "IDDWQ",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "114116100",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gwiggs353432@direct.tgh.org",
            "affiliation": "N",
            "address_1": "1303 W Kennedy Blvd",
            "city": "Tampa",
            "state": "FL",
            "country_code": "US",
            "postal_code": "336061848",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MARTY",
            "last_name": "WIGGS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Lakeland, FL

Sources for this page

Verify at the official NPI Registry.