# DPM HAIRSTON 01 FL LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1508988015
- **Authorized official:** DR. EARLIE OWENS HAIRSTON II D.P.M. (OWNER)
- **Authorized official phone:** (352) 683-6618

## Contact information

- **Practice address:** 12900 CORTEZ BLVD STE 102, BROOKSVILLE, FL 34613-6897
- **Practice address phone:** (352) 683-6618
- **Practice address fax:** (352) 683-5722
- **Mailing address:** 12900 CORTEZ BLVD STE 102, BROOKSVILLE, FL 34613-6897
- **Mailing address phone:** (352) 683-6618
- **Mailing address fax:** (352) 683-5722

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | K7562 | FL | Yes |

## Other

- **Enumeration date:** 04/04/2007
- **Last updated:** 01/30/2025