Provider Demographics
NPI:1194891150
Name:HALEY DERMATOLOGY LLC
Entity type:Organization
Organization Name:HALEY DERMATOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:R
Authorized Official - Last Name:HALEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-928-3844
Mailing Address - Street 1:202 ROCK CREEK PARKWAY
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-3349
Mailing Address - Country:US
Mailing Address - Phone:251-928-3844
Mailing Address - Fax:251-928-3353
Practice Address - Street 1:202 ROCK CREEK PKWY
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-3349
Practice Address - Country:US
Practice Address - Phone:251-928-3844
Practice Address - Fax:251-928-3353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510I07009Medicare PIN
AL051553779Medicare ID - Type Unspecified
ALH87226Medicare UPIN