Provider Demographics
NPI:1669577532
Name:HAIRSTON, JOHN C (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:HAIRSTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:16659 SOUTHWEST FWY
Mailing Address - Street 2:SUITE 225
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-2375
Mailing Address - Country:US
Mailing Address - Phone:281-313-7878
Mailing Address - Fax:281-313-7880
Practice Address - Street 1:16659 SOUTHWEST FWY
Practice Address - Street 2:SUITE 225
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2375
Practice Address - Country:US
Practice Address - Phone:281-313-7878
Practice Address - Fax:281-313-7880
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2008-05-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXL4417208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152994302Medicaid
TX5472630OtherCIGNA
TXP000388708OtherMEDICARE RAIL ROAD
TX4248755OtherBLUE LINK
TX007524368OtherAETNA
TX8W5050OtherBLUE CROSS BLUE SHIELD
TX8F4304Medicare PIN