MEDICARE: DIANNE LORY HIGGINS MD

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	207P00000X	Emergency Medicine Physician	A42102	CA
2	207Q00000X	Family Medicine Physician	10165	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	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	10165	OTHER	NV STATE LICENSE

General Provider Information

NPI Number	:	1558387449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANNE LORY HIGGINS MD

Provider Business Mailing Address
First Line	:	PO BOX 805
Second Line	:
City	:	NEVADA CITY
State	:	CA
Zip	:	95959-0805
Country	:	US
Telephone Number	:	530-271-3232
Fax Number	:	530-271-3239

Provider Business Practice Location Address
First Line	:	880 ALDER AVE
Second Line	:	SECOND FLOOR
City	:	INCLINE VILLAGE
State	:	NV
Zip	:	89451-8335
Country	:	US
Telephone Number	:	775-831-5308
Fax Number	:	775-831-3295

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	12/26/2013

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