Healthcare Provider Details

I. General information

NPI: 1891765806
Provider Name (Legal Business Name): DAVID BIGELOW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5575 ZEAMER AVE
JBER AK
99506
US

IV. Provider business mailing address

8704 ACADIA DR
EAGLE RIVER AK
99577-9028
US

V. Phone/Fax

Practice location:
  • Phone: 907-580-6775
  • Fax:
Mailing address:
  • Phone: 907-341-9084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number01062532A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number7551
License Number StateAK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierME159859
Identifier TypeOTHER
Identifier StateFL
Identifier IssuerFL DOH
# 2
Identifier116923200
Identifier TypeMEDICAID
Identifier StateFL
Identifier IssuerFlorida Medicaid Provider ID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: