Healthcare Provider Details

I. General information

NPI: 1235636150
Provider Name (Legal Business Name): HALEY CARLSON DAVIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HALEY MARIE CARLSON

II. Dates (important events)

Enumeration Date: 04/08/2018
Last Update Date: 05/04/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11600 W 2ND PL
LAKEWOOD CO
80228-1527
US

IV. Provider business mailing address

5700 SOUTHWYCK BLVD
TOLEDO OH
43614-1509
US

V. Phone/Fax

Practice location:
  • Phone: 720-321-0000
  • Fax: 419-866-5453
Mailing address:
  • Phone: 800-288-8325
  • Fax: 419-866-5453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberDR.0070197
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: