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NPI Code Detail

MEDICARE: MR. ALLAN EDWARD BIGTAS JR. MSW, LCSW, BCD

MEDICARE: MR. ALLAN EDWARD BIGTAS JR. MSW, LCSW, BCD
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
11041C0700XClinical Social Worker3263HI

General Provider Information

NPI Number : 1902880677
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ALLAN EDWARD BIGTAS JR. MSW, LCSW, BCD
Provider Business Mailing Address
First Line : 4700 LAS VEGAS BLVD N BLDG 1300
Second Line :
City : NELLIS AFB
State : NV
Zip : 89191-6600
Country : US
Telephone Number : 702-653-2369
Fax Number : 702-653-2369
Provider Business Practice Location Address
First Line : 4700 LAS VEGAS BLVD N BLDG 1300
Second Line :
City : NELLIS AFB
State : NV
Zip : 89191-6600
Country : US
Telephone Number : 702-653-2369
Fax Number : 702-653-2369
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/06/2005
Last Update Date : 04/21/2014

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