Healthcare Provider Details

I. General information

NPI: 1043211055
Provider Name (Legal Business Name): STEVEN K STAIRES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 04/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 KALISTE SALOOM RD SUITE 208
LAFAYETTE LA
70508-5783
US

IV. Provider business mailing address

PO BOX 53286
LAFAYETTE LA
70505-3286
US

V. Phone/Fax

Practice location:
  • Phone: 337-234-3757
  • Fax: 337-234-3733
Mailing address:
  • Phone: 337-234-3757
  • Fax: 337-234-3733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number16294
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: