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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