Healthcare Provider Details

I. General information

NPI: 1700847688
Provider Name (Legal Business Name): KERRY T HIGGINS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 08/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

799 E HAMPDEN AVE SUITE 300
ENGLEWOOD CO
80113-2700
US

IV. Provider business mailing address

PO BOX 60
ENGLEWOOD CO
80151-0060
US

V. Phone/Fax

Practice location:
  • Phone: 303-493-5200
  • Fax: 720-570-2012
Mailing address:
  • Phone: 303-493-5200
  • Fax: 720-570-2012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number18644
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: