Provider Demographics
NPI:1528042520
Name:HIGHSMITH, MARIA JANE (DPM)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:JANE
Last Name:HIGHSMITH
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 NUT TREE RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687
Mailing Address - Country:US
Mailing Address - Phone:707-448-8494
Mailing Address - Fax:707-448-7653
Practice Address - Street 1:1001 NUT TREE RD
Practice Address - Street 2:SUITE 220
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687
Practice Address - Country:US
Practice Address - Phone:707-448-8494
Practice Address - Fax:707-448-7653
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-02
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3457213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E34570Medicaid
CA000E34570Medicare PIN
T11660Medicare UPIN
CA000E34570Medicaid