Provider Demographics
NPI:1588217905
Name:HAIR, AMIDA (DPM)
Entity Type:Individual
Prefix:
First Name:AMIDA
Middle Name:
Last Name:HAIR
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2408 NE DIVISION ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-3543
Mailing Address - Country:US
Mailing Address - Phone:541-382-7521
Mailing Address - Fax:
Practice Address - Street 1:2408 NE DIVISION ST STE 100
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-3543
Practice Address - Country:US
Practice Address - Phone:313-343-3423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP217998213ES0103X
MI5951001371213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery