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Organization
SHANE HIGGINBOTHAM MD PA
Active
Organization
SHANE HIGGINBOTHAM MD PA
Active
Other names
Higginbotham Family Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
KIM OVERTON (OFFICE MANAGER)
(501) 337-9994
Entity
Organization
Contact information
Practice address
1002 SCHNEIDER DR, SUITE 104, MALVERN, AR 72104-4816
(501) 332-7981
(501) 337-9964
Mailing address
1002 SCHNEIDER DR, SUITE 104, MALVERN, AR 72104-4816
(501) 332-7981
(501) 337-9964
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
E0968
AR
363A00000X
Physician Assistant
PA251
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
205795002
—
AR
Enumeration date
08/08/2006
Last updated
05/06/2021
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