Healthcare Provider Details

I. General information

NPI: 1669492658
Provider Name (Legal Business Name): DENNIS G. HIGGINBOTHAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/24/2020
Certification Date: 07/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MT CARMEL WAY
PITTSBURG KS
66762-7587
US

IV. Provider business mailing address

1 MT CARMEL WAY
PITTSBURG KS
66762-7587
US

V. Phone/Fax

Practice location:
  • Phone: 620-230-0044
  • Fax: 620-230-0543
Mailing address:
  • Phone: 620-230-0044
  • Fax: 620-230-0543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD-107964
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number04-25345
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: