Healthcare Provider Details

I. General information

NPI: 1750407409
Provider Name (Legal Business Name): STEVEN M HACKER MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 06/01/2022
Certification Date: 06/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 GEORGE BUSH BLVD STE B
DELRAY BEACH FL
33444-4035
US

IV. Provider business mailing address

230 GEORGE BUSH BLVD STE B
DELRAY BEACH FL
33444-4035
US

V. Phone/Fax

Practice location:
  • Phone: 561-276-3111
  • Fax: 561-276-3319
Mailing address:
  • Phone: 561-276-3111
  • Fax: 561-276-3319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: SARAH BENTLEY
Title or Position: OFFICE MANAGER
Credential:
Phone: 561-593-4269