Provider Demographics
NPI:1790756641
Name:BIGGS, EDWARD J (IDC)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:J
Last Name:BIGGS
Suffix:
Gender:M
Credentials:IDC
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 180571
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92178-0571
Mailing Address - Country:US
Mailing Address - Phone:619-318-6726
Mailing Address - Fax:
Practice Address - Street 1:2446 TRIDENT WAY
Practice Address - Street 2:MEDICAL DEPARTMENT NSWC
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92155-5449
Practice Address - Country:US
Practice Address - Phone:619-437-0777
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman