Provider Demographics
NPI:1588617542
Name:BIGELOW, BARCLAY FISKE (MD)
Entity Type:Individual
Prefix:DR
First Name:BARCLAY
Middle Name:FISKE
Last Name:BIGELOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 E 9400 S
Mailing Address - Street 2:STE 105
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-3675
Mailing Address - Country:US
Mailing Address - Phone:801-571-7494
Mailing Address - Fax:801-495-3864
Practice Address - Street 1:880 E 9400 S
Practice Address - Street 2:SUITE 105
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-3675
Practice Address - Country:US
Practice Address - Phone:801-571-7494
Practice Address - Fax:801-495-3864
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT182027-1205207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000011908Medicare ID - Type Unspecified
TNE67652Medicare UPIN