Provider Demographics
NPI:1104893692
Name:BIGHAM, WILLIAM JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JOHN
Last Name:BIGHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1317 YNEZ PL STE A
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-3909
Mailing Address - Country:US
Mailing Address - Phone:619-435-8800
Mailing Address - Fax:619-435-9197
Practice Address - Street 1:1317 YNEZ PL STE A
Practice Address - Street 2:
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118-3909
Practice Address - Country:US
Practice Address - Phone:619-435-8800
Practice Address - Fax:619-435-9197
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG54117207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG54117EMedicare ID - Type Unspecified
I16410Medicare UPIN