Provider Demographics
NPI:1225013626
Name:HIGGINBOTHAM, CHANDRA GERMAINE (MD)
Entity type:Individual
Prefix:DR
First Name:CHANDRA
Middle Name:GERMAINE
Last Name:HIGGINBOTHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2368A RICE BLVD.
Mailing Address - Street 2:#463
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005
Mailing Address - Country:US
Mailing Address - Phone:713-571-2273
Mailing Address - Fax:713-571-2275
Practice Address - Street 1:2316 ARBOR ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-6082
Practice Address - Country:US
Practice Address - Phone:713-571-2273
Practice Address - Fax:713-571-2275
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-08
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJO525207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX117342904Medicaid
TX610566Medicare PIN
TX117342904Medicaid