Provider Demographics
NPI:1508868340
Name:SQUIRE, PIPER L (MD)
Entity Type:Individual
Prefix:
First Name:PIPER
Middle Name:L
Last Name:SQUIRE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1065 NE 125TH ST STE 409
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-5834
Mailing Address - Country:US
Mailing Address - Phone:305-891-0050
Mailing Address - Fax:305-503-7363
Practice Address - Street 1:1065 NE 125TH ST STE 206
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-5832
Practice Address - Country:US
Practice Address - Phone:305-891-0050
Practice Address - Fax:305-503-7363
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91808207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274902500Medicaid
FL16583UMedicare PIN
FL274902500Medicaid
FL139464Medicare UPIN