Provider Demographics
NPI:1578055505
Name:DESIR, STEIGMWARD (CERT HAIR LOSS SPECI)
Entity Type:Individual
Prefix:MR
First Name:STEIGMWARD
Middle Name:
Last Name:DESIR
Suffix:
Gender:M
Credentials:CERT HAIR LOSS SPECI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:472 E ASHLAND ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-2107
Mailing Address - Country:US
Mailing Address - Phone:347-328-7074
Mailing Address - Fax:
Practice Address - Street 1:472 E ASHLAND ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302
Practice Address - Country:US
Practice Address - Phone:347-328-7074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-05
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9021181744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management