Higginbotham, Bruce Wayne
Higginbotham, Bruce Wayne is an individual health care provider with primary practice located at 10510 Gravelly Lake Dr Sw Community Health Care, Lakewood WA 98499-5036. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Emergency Medicine. Allopathic & Osteopathic Physicians / Family Medicine is his primary health care specialty. Higginbotham, Bruce Wayne can be contacted via phone (253) 722-1837.Contact Information
Primary practice address
10510 Gravelly Lake Dr Sw Community Health Care
Lakewood WA 98499-5036
Phone: (253) 722-1837
Fax: (253) 722-1851
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | MD00043885 | Washington |
| Allopathic & Osteopathic Physicians / Emergency Medicine | 207P00000X | MD00043885 | Washington |
Profile Details
| NPI number | 1679544225 |
|---|---|
| LBN Legal business name | Higginbotham, Bruce Wayne |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 31st, 2006 |
| Last updated | Apr 2nd, 2012 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1679544225 | NPPES |
| Arkansas | Other | P00385219 | RAILROAD MEDICARE |
| Arkansas | MEDICAID | 164111001 | RAILROAD MEDICARE |
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