Basic Information
Provider Information | |||||||||
NPI: | 1144423351 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | STEELE | ||||||||
FirstName: | GAREN | ||||||||
MiddleName: | DAXTON | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 30532 | ||||||||
Address2: |   | ||||||||
City: | PENSACOLA | ||||||||
State: | FL | ||||||||
PostalCode: | 325031532 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8509163700 | ||||||||
FaxNumber: | 8509163710 | ||||||||
Practice Location | |||||||||
Address1: | 1040 GULF BREEZE PKWY | ||||||||
Address2: | SUITE 200 | ||||||||
City: | GULF BREEZE | ||||||||
State: | FL | ||||||||
PostalCode: | 325617809 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8509163700 | ||||||||
FaxNumber: | 8509163710 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/06/2007 | ||||||||
LastUpdateDate: | 07/05/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 2009-00137 | NC | N |   | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |   | 207X00000X | ME114795 | FL | Y |   | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |   |
ID Information
ID | Type | State | Issuer | Description | 5911565 | 05 | NC |   | MEDICAID | 008151400 | 05 | FL |   | MEDICAID | 14P25 | 01 | FL | FLORIDA BLUE | OTHER | 593-11041 | 01 | AL | BLUE CROSS BLUE SHIELD | OTHER | 145041 | 05 | AL |   | MEDICAID | 593-11042 | 01 | AL | BLUE CROSS BLUE SHIELD | OTHER | 145220 | 05 | AL |   | MEDICAID |