Provider Demographics
NPI:1215181201
Name:HIGGS, ROGER B (MD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:B
Last Name:HIGGS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2332
Mailing Address - Country:US
Mailing Address - Phone:206-363-6444
Mailing Address - Fax:
Practice Address - Street 1:500 5TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2332
Practice Address - Country:US
Practice Address - Phone:206-296-1092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-04
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00018768207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1734409Medicaid
AO4723Medicare UPIN
0102252Medicare PIN