Provider Demographics
NPI:1720180060
Name:HAILEY, ROBERT F (DPM)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:F
Last Name:HAILEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 SOUTH 6TH STREET
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066-2309
Mailing Address - Country:US
Mailing Address - Phone:270-247-9610
Mailing Address - Fax:270-247-4077
Practice Address - Street 1:333 SOUTH 6TH STREET
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-2309
Practice Address - Country:US
Practice Address - Phone:270-247-9610
Practice Address - Fax:270-247-4077
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY00127213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T54171Medicare UPIN
2003201Medicare ID - Type Unspecified