Provider Demographics
NPI:1518344373
Name:HIGGINS, DOMINIQUE MARIO OMAR (MD)
Entity Type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:MARIO OMAR
Last Name:HIGGINS
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 1:1350 RALEIGH RD
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-4412
Mailing Address - Country:US
Mailing Address - Phone:919-966-7890
Mailing Address - Fax:
Practice Address - Street 1:1350 RALEIGH RD
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-4412
Practice Address - Country:US
Practice Address - Phone:919-966-7890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-30
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME150032207T00000X
NC2022-02706207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty