Provider Demographics
NPI:1740386671
Name:BIGHAM, RONNY PERRY (PA-C)
Entity Type:Individual
Prefix:MR
First Name:RONNY
Middle Name:PERRY
Last Name:BIGHAM
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1226 MIDDLE RIVER RD
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-6330
Mailing Address - Country:US
Mailing Address - Phone:540-886-5777
Mailing Address - Fax:540-886-5776
Practice Address - Street 1:102 LACY B KING WAY
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-4594
Practice Address - Country:US
Practice Address - Phone:408-865-7775
Practice Address - Fax:408-886-5776
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA011006488363AM0700X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA011006488OtherVETERANS HEALTH