Healthcare Provider Details

I. General information

NPI: 1861429607
Provider Name (Legal Business Name): STEPHEN I HAIRE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PINELLAS ST
CLEARWATER FL
33756-3804
US

IV. Provider business mailing address

PO BOX 850001
ORLANDO FL
32885-0001
US

V. Phone/Fax

Practice location:
  • Phone: 727-461-8537
  • Fax:
Mailing address:
  • Phone: 904-482-1070
  • Fax: 904-482-1077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME0073466
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: