Provider Demographics
NPI:1306347679
Name:BIGDER, MARK (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:BIGDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MARK
Other - Middle Name:GREGORY
Other - Last Name:BIGDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4500 SAN PABLO RD S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-1865
Mailing Address - Country:US
Mailing Address - Phone:904-953-2000
Mailing Address - Fax:
Practice Address - Street 1:213 QUARRY ROAD
Practice Address - Street 2:STANFORD NEUROSCIENCE HEALTH CENTER
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-5979
Practice Address - Country:US
Practice Address - Phone:650-723-6469
Practice Address - Fax:650-320-9443
Is Sole Proprietor?:No
Enumeration Date:2018-02-22
Last Update Date:2020-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME145531207T00000X
CA153531207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery