Provider Demographics
NPI:1629029558
Name:HIRSH, STEVEN P (DPM)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:P
Last Name:HIRSH
Suffix:
Gender:M
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:PO BOX 48023
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33743-8023
Mailing Address - Country:US
Mailing Address - Phone:727-800-9958
Mailing Address - Fax:954-434-6463
Practice Address - Street 1:2950 GRIFFIN RD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-5648
Practice Address - Country:US
Practice Address - Phone:954-924-6151
Practice Address - Fax:954-434-6463
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38R101564000183500000X
FLP518795183500000X
FLPO0001789213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL029740200Medicaid
FL87973OtherB/C B/S
FL87973YMedicare PIN
FL0457730001Medicare NSC
FL029740200Medicaid