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General NPI Number Information
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NPI Number | 1861460446
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Entity Type | Individual
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Provider Name | DEBRA K HIGGINBOTHAM MD
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Gender | Female
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Dates
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Enumeration Date | 03/09/2006
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Last Update Date | 01/30/2024
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Provider Practice Location Address
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Address Line | 2019 GALISTEO ST STE N9A
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City | SANTA FE
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State | NM
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Zip | 87505-2111
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Country | US
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Telephone | 505-820-1482
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Fax | 505-982-0696
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Provider Business Mailing Address
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Address Line | 2019 GALISTEO ST STE N9A
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City | SANTA FE
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State | NM
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Zip | 87505-2111
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Country | US
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Telephone | 505-820-1482
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Fax | 505-982-0696
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2000-208
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License Number State | NM
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