Provider Demographics
NPI:1154356137
Name:HIGGINS, GEORGE EDWARD (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:EDWARD
Last Name:HIGGINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6123 CASA DE VIDA NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-1140
Mailing Address - Country:US
Mailing Address - Phone:505-314-3142
Mailing Address - Fax:888-874-3330
Practice Address - Street 1:711 ENCINO PL NE STE D
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2650
Practice Address - Country:US
Practice Address - Phone:505-314-3142
Practice Address - Fax:888-874-3330
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM86245207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM38950Medicaid
NM38950Medicaid
NMNMB2345Medicare UPIN