Provider Demographics
NPI:1538126719
Name:BIGHAM, GENE O (MD)
Entity type:Individual
Prefix:
First Name:GENE
Middle Name:O
Last Name:BIGHAM
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 1:2727 BOLTON BOONE DR STE 114
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2019
Mailing Address - Country:US
Mailing Address - Phone:469-857-3142
Mailing Address - Fax:469-857-3077
Practice Address - Street 1:2727 BOLTON BOONE DR STE 114
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2019
Practice Address - Country:US
Practice Address - Phone:469-857-3142
Practice Address - Fax:469-857-3077
Is Sole Proprietor?:No
Enumeration Date:2006-04-30
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6337207RG0300X, 207RH0002X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX103403504Medicaid
TX82V275OtherBCBS
TX345275701Medicaid
TX103403504Medicaid
TX8F0233Medicare PIN
TXTXB125131Medicare PIN
TX103403504Medicaid
TX82V275Medicare PIN