Provider Demographics
NPI:1588645352
Name:HIGGINS, KEVIN R (DPM)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:R
Last Name:HIGGINS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8811 VILLAGE DR STE 150
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5415
Mailing Address - Country:US
Mailing Address - Phone:210-657-2644
Mailing Address - Fax:210-657-6834
Practice Address - Street 1:8811 VILLAGE DR STE 150
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5415
Practice Address - Country:US
Practice Address - Phone:210-657-2644
Practice Address - Fax:210-657-6834
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0980213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092769101Medicaid
T13831Medicare UPIN
TX092769101Medicaid