Provider Demographics
NPI:1720087646
Name:HAILE, DAVID JERRY (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JERRY
Last Name:HAILE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1424 US HIGHWAY 1
Mailing Address - Street 2:SUITE A
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958
Mailing Address - Country:US
Mailing Address - Phone:772-589-3110
Mailing Address - Fax:772-388-1929
Practice Address - Street 1:1424 US HIGHWAY 1
Practice Address - Street 2:SUITE A
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958
Practice Address - Country:US
Practice Address - Phone:772-589-3110
Practice Address - Fax:772-388-1929
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPO2469213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU56088Medicare UPIN
U56088Medicare UPIN