Provider Demographics
NPI:1649271131
Name:HIGGINS, STANLEY MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:MICHAEL
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 1:13737 NOEL RD STE 1600
Mailing Address - Street 2:ATTN RAYS
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-1374
Mailing Address - Country:US
Mailing Address - Phone:303-933-8270
Mailing Address - Fax:214-712-2002
Practice Address - Street 1:13737 NOEL RD STE 1600
Practice Address - Street 2:ATTN RAYS
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-1374
Practice Address - Country:US
Practice Address - Phone:303-933-8270
Practice Address - Fax:214-712-2002
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL844542085N0700X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264440100Medicaid
FL12020XMedicare PIN
FL264440100Medicaid