Healthcare Provider Details

I. General information

NPI: 1023071495
Provider Name (Legal Business Name): ERIC A HIGGINBOTHAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 06/12/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8611 N MOPAC EXPY # 300
AUSTIN TX
78759-8319
US

IV. Provider business mailing address

PO BOX 30727
CHARLOTTE NC
28230-0727
US

V. Phone/Fax

Practice location:
  • Phone: 737-220-8200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberM4155
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberM4155
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: