Organization
DPM HAIRSTON 01 FL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EARLIE OWENS HAIRSTON II D.P.M. (OWNER)
(352) 683-6618
Entity
Organization
Contact information
Practice address
12900 CORTEZ BLVD STE 102, BROOKSVILLE, FL 34613-6897
(352) 683-6618
(352) 683-5722
Mailing address
12900 CORTEZ BLVD STE 102, BROOKSVILLE, FL 34613-6897
(352) 683-6618
(352) 683-5722
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
K7562
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
340486200
—
FL
Enumeration date
04/04/2007
Last updated
01/30/2025
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