Provider Demographics
NPI:1609062892
Name:BIGMAN, BRUCE LAURIE (MD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:LAURIE
Last Name:BIGMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME20517207R00000X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL64303Medicare PIN