Provider Demographics
NPI:1811188030
Name:HIGGS, RONALD DALE (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:DALE
Last Name:HIGGS
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 68
Mailing Address - Street 2:
Mailing Address - City:ROCKWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37854-0068
Mailing Address - Country:US
Mailing Address - Phone:865-354-4088
Mailing Address - Fax:
Practice Address - Street 1:500 FLAT FORK ROAD
Practice Address - Street 2:MORGAN COUNTY CORRECTIONAL COMPLES
Practice Address - City:WARTBURG
Practice Address - State:TN
Practice Address - Zip Code:37887
Practice Address - Country:US
Practice Address - Phone:423-346-6641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN020423207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNE40682Medicare UPIN