Healthcare Provider Details

I. General information

NPI: 1386668234
Provider Name (Legal Business Name): RICHARD EUGENE HAIRE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 EMERSON BAY RD STE 102
CAROLINA SHORES NC
28467-2498
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 910-579-8363
  • Fax: 910-579-8306
Mailing address:
  • Phone: 910-579-8363
  • Fax: 910-579-8306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00194
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2160
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-08101
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: