Provider Demographics
NPI:1285799593
Name:HAIRE, HENRY MADISON (MD)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:MADISON
Last Name:HAIRE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 GLADES RD
Mailing Address - Street 2:400-A
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6461
Mailing Address - Country:US
Mailing Address - Phone:561-955-2570
Mailing Address - Fax:561-955-2572
Practice Address - Street 1:670 GLADES RD
Practice Address - Street 2:400-A
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6461
Practice Address - Country:US
Practice Address - Phone:561-955-5365
Practice Address - Fax:561-955-3577
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2016-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-15019207R00000X
FLME 28988207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL064928700Medicaid
FL064928700Medicaid
FLC76944Medicare UPIN