Provider Demographics
NPI:1578856274
Name:BIGBY, LAMAR (AA)
Entity Type:Individual
Prefix:
First Name:LAMAR
Middle Name:
Last Name:BIGBY
Suffix:
Gender:M
Credentials:AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4248 THOMAS PATRICK AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-8941
Mailing Address - Country:US
Mailing Address - Phone:702-287-0177
Mailing Address - Fax:
Practice Address - Street 1:6711 W ALEXANDER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-5170
Practice Address - Country:US
Practice Address - Phone:702-330-9069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-27
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner