Individual
DR. BRUCE WAYNE HIGGINBOTHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10510 GRAVELLY LAKE DR SW, COMMUNITY HEALTH CARE, LAKEWOOD, WA 98499-5036
(253) 722-1837
(253) 722-1851
Mailing address
101 E 26TH STREET, TACOMA, WA 98421
(253) 722-1837
(253) 722-1851
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
MD00043885
WA
207Q00000X
Family Medicine Physician
Primary
MD00043885
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
164111001
—
AR
01
—
P00385219
RAILROAD MEDICARE
AR
Enumeration date
01/31/2006
Last updated
04/02/2012
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