Provider Demographics
NPI:1700847688
Name:HIGGINS, KERRY T (MD)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:T
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:PO BOX 60
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80151-0060
Mailing Address - Country:US
Mailing Address - Phone:303-493-5200
Mailing Address - Fax:720-570-2012
Practice Address - Street 1:799 E HAMPDEN AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2700
Practice Address - Country:US
Practice Address - Phone:303-493-5200
Practice Address - Fax:720-570-2012
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO18644207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01186444Medicaid
COC805574Medicare PIN
CO01186444Medicaid