Basic Information
Provider Information
NPI: 1194861351
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HIGGS
FirstName: DOUGLAS
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 281 LINCOLN ST
Address2: MED STAFF SVCS
City: WORCESTER
State: MA
PostalCode: 016052138
CountryCode: US
TelephoneNumber: 5083348015
FaxNumber:  
Practice Location
Address1: 281 LINCOLN ST
Address2: MED STAFF SVCS
City: WORCESTER
State: MA
PostalCode: 016052138
CountryCode: US
TelephoneNumber: 5083348015
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/29/2007
LastUpdateDate: 12/26/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000X234204MAY Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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