Healthcare Provider Details

I. General information

NPI: 1730160607
Provider Name (Legal Business Name): PAUL R. BIGGS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 10/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1223 GATEWAY DRIVE
MELBOURNE FL
32901-2607
US

IV. Provider business mailing address

65 EAST NASA BLVD. SUITE 202
MELBOURNE FL
32901
US

V. Phone/Fax

Practice location:
  • Phone: 321-725-4500
  • Fax: 321-409-1786
Mailing address:
  • Phone: 321-733-0663
  • Fax: 321-409-1786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberME41416
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: