Healthcare Provider Details

I. General information

NPI: 1821045584
Provider Name (Legal Business Name): GLENN E BIGSBY IV DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 01/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7780 SOUTH BROADWAY SUITE 300
LITTLETON CO
80122-2633
US

IV. Provider business mailing address

7780 SOUTH BROADWAY SUITE 300
LITTLETON CO
80122-2633
US

V. Phone/Fax

Practice location:
  • Phone: 303-955-7574
  • Fax: 720-242-9307
Mailing address:
  • Phone: 303-955-7574
  • Fax: 720-242-9307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number0054364
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: