Healthcare Provider Details

I. General information

NPI: 1306953450
Provider Name (Legal Business Name): SHAWN M HIGGINS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 01/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 AUBURN ST SUITE 106
PORTLAND ME
04103-2141
US

IV. Provider business mailing address

94 AUBURN ST SUITE 106
PORTLAND ME
04103-2141
US

V. Phone/Fax

Practice location:
  • Phone: 207-615-6956
  • Fax: 207-850-2228
Mailing address:
  • Phone: 207-615-6956
  • Fax: 207-850-2228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberDO2056
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO2056
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: