Healthcare Provider Details

I. General information

NPI: 1952350837
Provider Name (Legal Business Name): BOBBY RAY HALEY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 PATRICIA AVE
DUNEDIN FL
34698-8103
US

IV. Provider business mailing address

PO BOX 10744
CLEARWATER FL
33757-8744
US

V. Phone/Fax

Practice location:
  • Phone: 727-733-4193
  • Fax: 727-736-3609
Mailing address:
  • Phone: 727-532-0002
  • Fax: 727-532-1318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS2920
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: