Provider Demographics
NPI:1730342551
Name:BIDGOOD, WILLIS D JR (MD, MS, MDIV)
Entity type:Individual
Prefix:
First Name:WILLIS
Middle Name:D
Last Name:BIDGOOD
Suffix:JR
Gender:M
Credentials:MD, MS, MDIV
Other - Prefix:
Other - First Name:W.
Other - Middle Name:DEAN
Other - Last Name:BIDGOOD
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD, MS, MDIV
Mailing Address - Street 1:THE UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL
Mailing Address - Street 2:CAMPUS BOX 7510
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-7510
Mailing Address - Country:US
Mailing Address - Phone:919-966-3085
Mailing Address - Fax:
Practice Address - Street 1:THE UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL
Practice Address - Street 2:CAMPUS BOX 7510
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-7510
Practice Address - Country:US
Practice Address - Phone:919-966-3085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC239132085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL654353Medicaid
NC8915442Medicaid
FL654353Medicaid