Provider Demographics
NPI:1598708166
Name:HIGGINS, JOSEPH LIONEL JR (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:LIONEL
Last Name:HIGGINS
Suffix:JR
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 1:101 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-0556
Mailing Address - Country:US
Mailing Address - Phone:209-571-6622
Mailing Address - Fax:209-527-2069
Practice Address - Street 1:1524 MCHENRY AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4500
Practice Address - Country:US
Practice Address - Phone:209-577-4444
Practice Address - Fax:209-527-2069
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG678702085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G678700Medicaid
CA00G6787014Medicare PIN
CA00G678702Medicare PIN
CA00G678707Medicare PIN
CA00G6787013Medicare PIN
CA00G678704Medicare PIN
CA00G678700Medicare PIN
CA00G678706Medicare PIN
CA00G678701Medicare PIN
CA00G678700Medicaid
CA00G6787012Medicare PIN
CA00G678708Medicare PIN
CA00G6787011Medicare PIN
CA00G678709Medicare PIN
CA00G6787010Medicare PIN
CA00G678703Medicare PIN
CA00G678705Medicare PIN
CA300133278Medicare PIN