Healthcare Provider Details

I. General information

NPI: 1932104304
Provider Name (Legal Business Name): LAWRENCE ROY BIGONGIARI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 03/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 S MAIN ST
HOPE AR
71801-8124
US

IV. Provider business mailing address

PO BOX 611
NASHVILLE AR
71852-0611
US

V. Phone/Fax

Practice location:
  • Phone: 870-722-2457
  • Fax: 870-845-3554
Mailing address:
  • Phone: 870-845-5718
  • Fax: 870-845-3554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberE1357
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: