Healthcare Provider Details

I. General information

NPI: 1679674345
Provider Name (Legal Business Name): IRMA HIGGINBOTHAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 08/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 5TH AVE E
TUSCALOOSA AL
35487-0001
US

IV. Provider business mailing address

PO BOX 870360
TUSCALOOSA AL
35487-0001
US

V. Phone/Fax

Practice location:
  • Phone: 205-348-6262
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number27566
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: