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General NPI Number Information
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NPI Number | 1306984943
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Entity Type | Organization
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Legal Business Name | RONALD S HIGGINBOTHAM, DO PA
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Dates
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Enumeration Date | 02/04/2007
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Last Update Date | 04/09/2015
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Provider Practice Location Address
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Address Line | 7685 W EMERALD ST
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City | BOISE
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State | ID
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Zip | 83704-9018
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Country | US
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Telephone | 208-376-2522
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Fax | 208-375-5860
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Provider Business Mailing Address
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Address Line | 7685 W EMERALD ST
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City | BOISE
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State | ID
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Zip | 83704-9018
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Country | US
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Telephone | 208-376-2522
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Fax | 208-375-5860
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. AMY E HUMMEL
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Credential |
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Telephone | 208-376-2522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | O-50
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License Number State | ID
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