Basic Information
| Provider Information | |||||||||
| NPI: | 1205867058 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HIGGINS | ||||||||
| FirstName: | HERBERT | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 NOKOMIS AVE S | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | VENICE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342853209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9414838564 | ||||||||
| FaxNumber: | 9414837606 | ||||||||
| Practice Location | |||||||||
| Address1: | 1700 E. VENICE AVENUE | ||||||||
| Address2: | |||||||||
| City: | VENICE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342923190 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9414839760 | ||||||||
| FaxNumber: | 9414839775 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 08/15/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 5624 | AK | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | ME0081881 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0211595 | 01 | AK | WA L&I | OTHER | MD1879 | 05 | AK | MEDICAID |