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General NPI Number Information
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NPI Number | 1205068236
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Entity Type | Organization
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Legal Business Name | GEORGE HIGGINS FAMILY PRACTICE LLC
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Dates
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Enumeration Date | 08/08/2009
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Last Update Date | 10/13/2009
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Provider Practice Location Address
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Address Line | 711 ENCINO PL NE SUITE D
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City | ALBUQUERQUE
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State | NM
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Zip | 87102-2619
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Country | US
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Telephone | 505-314-3142
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Fax | 888-874-3330
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Provider Business Mailing Address
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Address Line | 711 ENCINO PL NE SUITE D
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City | ALBUQUERQUE
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State | NM
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Zip | 87102-2619
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Country | US
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Telephone | 505-314-3142
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Fax | 888-874-3330
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Authorized Official
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Title or Position | OWNER
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Name | DR. GEORGE EDWARD HIGGINS
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Credential | MD
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Telephone | 505-314-3142
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 86-245
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License Number State | NM
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