Provider Demographics
NPI:1407812217
Name:HIGHTOWER, STEVEN IRISH (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:IRISH
Last Name:HIGHTOWER
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 1:257 AMELIA LN
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-5604
Mailing Address - Country:US
Mailing Address - Phone:504-427-7254
Mailing Address - Fax:
Practice Address - Street 1:257 AMELIA LN
Practice Address - Street 2:
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459-5604
Practice Address - Country:US
Practice Address - Phone:504-427-7254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0142662085R0001X
WAMD606516682085R0001X
ORMD1733092085R0001X
FLME1275582085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1315532Medicaid
LA5M142Medicare PIN
B61666Medicare UPIN