Basic Information
| Provider Information | |||||||||
| NPI: | 1306347679 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BIGDER | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | BIGDER | ||||||||
| OtherFirstName: | MARK | ||||||||
| OtherMiddleName: | GREGORY | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4500 SAN PABLO RD S | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322241865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9049532000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 213 QUARRY ROAD | ||||||||
| Address2: | STANFORD NEUROSCIENCE HEALTH CENTER | ||||||||
| City: | PALO ALTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 943045979 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6507236469 | ||||||||
| FaxNumber: | 6503209443 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2018 | ||||||||
| LastUpdateDate: | 05/23/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 05/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | ME145531 | FL | Y | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | 153531 | CA | N | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.