Basic Information
| Provider Information | |||||||||
| NPI: | 1730160607 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BIGGS | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | R. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 65 EAST NASA BLVD. | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | MELBOURNE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3217330663 | ||||||||
| FaxNumber: | 3214091786 | ||||||||
| Practice Location | |||||||||
| Address1: | 1223 GATEWAY DRIVE | ||||||||
| Address2: | |||||||||
| City: | MELBOURNE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329012607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3217254500 | ||||||||
| FaxNumber: | 3214091786 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2005 | ||||||||
| LastUpdateDate: | 10/01/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QG0300X | ME41416 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 9908451 | 01 | FL | CIGNA | OTHER | 080104964 | 01 | FL | RAILROAD MEDICARE | OTHER | 0809703 | 01 | FL | AETNA | OTHER | 378230100 | 05 | FL | MEDICAID | 26867 | 01 | FL | BLUE CROSS BLUE SHIELD | OTHER | 5146027 | 01 | FL | AETNA | OTHER |