MEDICARE: WILLIS D. BIDGOOD JR. M.D., M.S., M.DIV.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	23913	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730342551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIS D. BIDGOOD JR. M.D., M.S., M.DIV.

Provider Business Mailing Address
First Line	:	THE UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL
Second Line	:	CAMPUS BOX 7510
City	:	CHAPEL HILL
State	:	NC
Zip	:	27599-7510
Country	:	US
Telephone Number	:	919-966-3085
Fax Number	:

Provider Business Practice Location Address
First Line	:	THE UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL
Second Line	:	CAMPUS BOX 7510
City	:	CHAPEL HILL
State	:	NC
Zip	:	27599-7510
Country	:	US
Telephone Number	:	919-966-3085
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2008
Last Update Date	:	07/02/2008

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