Provider Demographics
NPI:1043211055
Name:STAIRES, STEVEN K (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:K
Last Name:STAIRES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 53286
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70505-3286
Mailing Address - Country:US
Mailing Address - Phone:337-234-3757
Mailing Address - Fax:337-234-3733
Practice Address - Street 1:1103 KALISTE SALOOM RD
Practice Address - Street 2:SUITE 208
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-5783
Practice Address - Country:US
Practice Address - Phone:337-234-3757
Practice Address - Fax:337-234-3733
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16294207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1360490Medicaid
LA51566Medicare ID - Type Unspecified
LA1360490Medicaid