MEDICARE: HIGLEY FAMILY MEDICINE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	2399	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366626400
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIGLEY FAMILY MEDICINE, LLC

Provider Business Mailing Address
First Line	:	1425 S HIGLEY RD
Second Line	:	SUITE 102
City	:	GILBERT
State	:	AZ
Zip	:	85296-4798
Country	:	US
Telephone Number	:	480-988-6878
Fax Number	:	480-988-6879

Provider Business Practice Location Address
First Line	:	1425 S HIGLEY RD
Second Line	:	SUITE 102
City	:	GILBERT
State	:	AZ
Zip	:	85296-4798
Country	:	US
Telephone Number	:	480-988-6878
Fax Number	:	480-988-6879

Authorized Official
Title or Position	:	OWNER/PHYSICIAN ASSISTANT
Name	:	TREVOR W WHITMORE
Credential	:	P.A.
Telephone Number	:	480-988-6878

Provider Enumeration Date	:	12/26/2007
Last Update Date	:	06/13/2008

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Directions to “HIGLEY FAMILY MEDICINE, LLC ” Practice Location

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