Provider Demographics
NPI:1861456998
Name:HIGHAM, ROBERT C (PA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:C
Last Name:HIGHAM
Suffix:
Gender:M
Credentials:PA
Other - Prefix:MR
Other - First Name:ROBERT
Other - Middle Name:CHRISTOPHER
Other - Last Name:HIGHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:4836 VAN NUYS BLVD
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-2101
Mailing Address - Country:US
Mailing Address - Phone:818-907-7546
Mailing Address - Fax:818-907-9506
Practice Address - Street 1:4836 VAN NUYS BLVD
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-2101
Practice Address - Country:US
Practice Address - Phone:818-907-7546
Practice Address - Fax:818-907-9506
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15099A363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPA15099AMedicare ID - Type UnspecifiedMCRE ID#
CAS98888Medicare UPIN