Basic Information
| Provider Information | |||||||||
| NPI: | 1861513830 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BIGGERS | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | SCOTT | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 416 W 15TH ST | ||||||||
| Address2: | BLDG 300 | ||||||||
| City: | EDMOND | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730133673 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4058441830 | ||||||||
| FaxNumber: | 4053419217 | ||||||||
| Practice Location | |||||||||
| Address1: | 3214 E RACE AVE | ||||||||
| Address2: | |||||||||
| City: | SEARCY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721434810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5012686121 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2007 | ||||||||
| LastUpdateDate: | 10/26/2009 | ||||||||
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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 | 207PE0004X | E-5366 | AR | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services | 390200000X | AR | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
ID Information
| ID | Type | State | Issuer | Description | 5H12156972 | 01 | MEDICARE LINKD | OTHER | 168600001 | 05 | AR | MEDICAID |