Basic Information
| Provider Information | |||||||||
| NPI: | 1518344373 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HIGGINS | ||||||||
| FirstName: | DOMINIQUE | ||||||||
| MiddleName: | MARIO OMAR | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1350 RALEIGH RD | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275174412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199667890 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1350 RALEIGH RD | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275174412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199667890 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2015 | ||||||||
| LastUpdateDate: | 10/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | ME150032 | FL | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | 2022-02706 | NC | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.