Provider Demographics
NPI:1427073386
Name:RIGDON, EDWARD E (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:E
Last Name:RIGDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6019
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-3919
Mailing Address - Country:US
Mailing Address - Phone:601-825-1975
Mailing Address - Fax:601-825-4127
Practice Address - Street 1:348 CROSSGATES BLVD
Practice Address - Street 2:SUITE 2500
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-2700
Practice Address - Country:US
Practice Address - Phone:601-825-1975
Practice Address - Fax:601-825-4127
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS84122086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00121392Medicaid
MS020000375Medicare PIN
MS00121392Medicaid