Healthcare Provider Details

I. General information

NPI: 1871589499
Provider Name (Legal Business Name): STEPHEN WAYNE HIGGINS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 09/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 DAVIS AVE E
BARKSDALE AFB LA
71110-2278
US

IV. Provider business mailing address

245 DAVIS AVE E
BARKSDALE AFB LA
71110-2278
US

V. Phone/Fax

Practice location:
  • Phone: 318-456-0483
  • Fax:
Mailing address:
  • Phone: 318-456-0483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME60534
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: