Healthcare Provider Details

I. General information

NPI: 1790111664
Provider Name (Legal Business Name): STEVEN B LAYE PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2013
Last Update Date: 04/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 ROSS CLARK CIR
DOTHAN AL
36301
US

IV. Provider business mailing address

1500 ROSS CLARK CIR
DOTHAN AL
36301-4754
US

V. Phone/Fax

Practice location:
  • Phone: 334-793-2663
  • Fax: 334-836-2248
Mailing address:
  • Phone: 334-793-2663
  • Fax: 334-836-2248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA-925
License Number StateAL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierPA-925
Identifier TypeOTHER
Identifier StateAL
Identifier IssuerALABAMA LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: