=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588645352
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEVIN R HIGGINS DPM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/09/2005
-----------------------------------------------------
Last Update Date | 04/18/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8811 VILLAGE DR STE 150
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78217-5415
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-657-2644
-----------------------------------------------------
Fax | 210-657-6834
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8811 VILLAGE DR STE 150
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78217-5415
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-657-2644
-----------------------------------------------------
Fax | 210-657-6834
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | 0980
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------