Healthcare Provider Details

I. General information

NPI: 1629029558
Provider Name (Legal Business Name): STEVEN P HIRSH DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 07/09/2020
Certification Date: 07/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 GRIFFIN RD
FORT LAUDERDALE FL
33312-5648
US

IV. Provider business mailing address

PO BOX 48023
ST PETERSBURG FL
33743-8023
US

V. Phone/Fax

Practice location:
  • Phone: 954-924-6151
  • Fax: 954-434-6463
Mailing address:
  • Phone: 727-800-9958
  • Fax: 954-434-6463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number38R101564000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP518795
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO0001789
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: