Provider Demographics
NPI:1689642332
Name:BIGHAM, THOMAS HOLLAND (DO)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:HOLLAND
Last Name:BIGHAM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:168 NORTH 100 EAST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ST. GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-3197
Mailing Address - Country:US
Mailing Address - Phone:435-986-2565
Mailing Address - Fax:435-986-2577
Practice Address - Street 1:168 NORTH 100 EAST
Practice Address - Street 2:SUITE 101
Practice Address - City:ST. GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3197
Practice Address - Country:US
Practice Address - Phone:435-986-2565
Practice Address - Fax:435-986-2565
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2009-08-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ4097207Q00000X
UT5333623-1204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1689642332Medicaid
UT1689642332Medicaid
AZI03154Medicare UPIN