# RONALD S HIGGINBOTHAM, DO PA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Boise Osteopathic Medical Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306984943
- **Authorized official:** MS. AMY E HUMMEL (OFFICE MANAGER)
- **Authorized official phone:** (208) 376-2522

## Contact information

- **Practice address:** 7685 W EMERALD ST, BOISE, ID 83704-9018
- **Practice address phone:** (208) 376-2522
- **Practice address fax:** (208) 375-5860
- **Mailing address:** 7685 W EMERALD ST, BOISE, ID 83704-9018
- **Mailing address phone:** (208) 376-2522
- **Mailing address fax:** (208) 375-5860

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | O-50 | ID | Yes |

## Other

- **Enumeration date:** 02/04/2007
- **Last updated:** 04/09/2015