Provider Demographics
NPI:1922074228
Name:HAIRE, CAROLE ANNE DYE (DO)
Entity Type:Individual
Prefix:
First Name:CAROLE ANNE
Middle Name:DYE
Last Name:HAIRE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:
Other - Last Name:HAIRE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:P.O. BOX 2484
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38803
Mailing Address - Country:US
Mailing Address - Phone:662-205-4652
Mailing Address - Fax:662-205-4651
Practice Address - Street 1:2633 TRACELAND DRIVE
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801
Practice Address - Country:US
Practice Address - Phone:662-205-4652
Practice Address - Fax:662-205-4651
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16935207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00126275Medicaid
MS00126275Medicaid