Provider Demographics
NPI:1366523748
Name:DEESIII, STRAWFORD HALE (MD)
Entity type:Individual
Prefix:
First Name:STRAWFORD
Middle Name:HALE
Last Name:DEESIII
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 1:1720A MEDICAL PARK DR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-2129
Mailing Address - Country:US
Mailing Address - Phone:228-392-4454
Mailing Address - Fax:228-392-4533
Practice Address - Street 1:1720A MEDICAL PARK DR
Practice Address - Street 2:SUITE 140
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-2129
Practice Address - Country:US
Practice Address - Phone:228-392-4454
Practice Address - Fax:228-392-4533
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS06399208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS240000025Medicare ID - Type Unspecified