Healthcare Provider Details

I. General information

NPI: 1851779367
Provider Name (Legal Business Name): ALEXANDER P HALEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2015
Last Update Date: 09/06/2024
Certification Date: 09/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35TH MEDICAL GROUP UNIT 5024
APO AP
96319-5024
US

IV. Provider business mailing address

35TH MEDICAL GROUP UNIT 5024
APO AP
96319-0800
US

V. Phone/Fax

Practice location:
  • Phone: 314-226-6490
  • Fax:
Mailing address:
  • Phone: 314-226-6490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number29429
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberP31340
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number29429
License Number StateNE
# 4
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number29429
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: