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General NPI Number Information
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NPI Number | 1366626400
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Entity Type | Organization
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Legal Business Name | HIGLEY FAMILY MEDICINE, LLC
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Dates
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Enumeration Date | 12/26/2007
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Last Update Date | 06/13/2008
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Provider Practice Location Address
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Address Line | 1425 S HIGLEY RD SUITE 102
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City | GILBERT
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State | AZ
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Zip | 85296-4798
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Country | US
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Telephone | 480-988-6878
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Fax | 480-988-6879
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Provider Business Mailing Address
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Address Line | 1425 S HIGLEY RD SUITE 102
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City | GILBERT
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State | AZ
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Zip | 85296-4798
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Country | US
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Telephone | 480-988-6878
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Fax | 480-988-6879
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Authorized Official
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Title or Position | OWNER/PHYSICIAN ASSISTANT
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Name | TREVOR W WHITMORE
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Credential | P.A.
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Telephone | 480-988-6878
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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 | 2399
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License Number State | AZ
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