Provider Demographics
NPI:1184603805
Name:HAIRE, WILLIAM CALVIN JR (DO)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CALVIN
Last Name:HAIRE
Suffix:JR
Gender:M
Credentials:DO
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 1529
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38606-4029
Mailing Address - Country:US
Mailing Address - Phone:662-563-4641
Mailing Address - Fax:662-563-4099
Practice Address - Street 1:107A EUREKA ST
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606-2533
Practice Address - Country:US
Practice Address - Phone:662-563-4641
Practice Address - Fax:662-563-4099
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS10476207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS010060435OtherRAILROAD MEDICARE
MS00014378Medicaid
MS4401733OtherCIGNA
MS4401733OtherCIGNA
MSC02499Medicare UPIN
MSD80583Medicare UPIN
MS00014378Medicaid