Provider Demographics
NPI:1912978586
Name:BIGELOW, JOHN R JR (PSYD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:R
Last Name:BIGELOW
Suffix:JR
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC
Mailing Address - State:IA
Mailing Address - Zip Code:50022
Mailing Address - Country:US
Mailing Address - Phone:712-243-2606
Mailing Address - Fax:712-243-2688
Practice Address - Street 1:1500 E 10TH ST
Practice Address - Street 2:
Practice Address - City:ATLANTIC
Practice Address - State:IA
Practice Address - Zip Code:50022
Practice Address - Country:US
Practice Address - Phone:712-243-2606
Practice Address - Fax:712-243-2688
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00889103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0008938Medicaid
IA0008938Medicaid
17552Medicare ID - Type UnspecifiedNON BILLING