Provider Demographics
NPI:1568611655
Name:HIGGINS, DEREK C (DO)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:C
Last Name:HIGGINS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4915 E BASELINE RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2966
Mailing Address - Country:US
Mailing Address - Phone:480-249-5525
Mailing Address - Fax:888-990-2056
Practice Address - Street 1:4915 E BASELINE RD
Practice Address - Street 2:SUITE 108
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2966
Practice Address - Country:US
Practice Address - Phone:480-249-5525
Practice Address - Fax:888-990-2056
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-12
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ005569208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ005569OtherMEDICAL LICENSE