Provider Demographics
NPI:1891727624
Name:BRUCE L BIGMAN MD PA
Entity Type:Organization
Organization Name:BRUCE L BIGMAN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BIGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-734-2214
Mailing Address - Street 1:230 E NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-5522
Mailing Address - Country:US
Mailing Address - Phone:386-734-2214
Mailing Address - Fax:386-734-2241
Practice Address - Street 1:230 E NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-5522
Practice Address - Country:US
Practice Address - Phone:386-734-2214
Practice Address - Fax:386-734-2241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0563385400Medicaid
D27090Medicare UPIN
64303Medicare PIN