Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 0101056188 | VA |
NPI | 1003812785 |
---|---|
Provider Name | Patrick B. Higdon |
First Address | Norfolk, VA 23502-3920 |
Second Address | Norfolk, VA 23502-3920 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2005 |
Last Update Date | 18/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
080180925 | RR MEDICARE (01) | VA |
291974 | ANTHEM (01) | VA |
5630592 | (05) | VA |
G97766 | (02) | VA |