Provider Demographics
NPI:1043393663
Name:BIGELOW, JAMIE MARIE (MD)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:MARIE
Last Name:BIGELOW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1023
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94948-1023
Mailing Address - Country:US
Mailing Address - Phone:415-234-6100
Mailing Address - Fax:415-234-6500
Practice Address - Street 1:815 HYDE ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-5996
Practice Address - Country:US
Practice Address - Phone:415-673-7515
Practice Address - Fax:415-563-6259
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG076533207RP1001X, 207RS0012X
CAG07655207RC0200X
CAG765332083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00G765330Medicare ID - Type Unspecified
G47408Medicare UPIN