Healthcare Provider Details

I. General information

NPI: 1972578516
Provider Name (Legal Business Name): HENRY MILFRED HALEY JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4720 S I 10 SERVICE RD W STE 406
METAIRIE LA
70001-1242
US

IV. Provider business mailing address

925 JEFFERSON AVE
NEW ORLEANS LA
70115-3026
US

V. Phone/Fax

Practice location:
  • Phone: 504-456-3155
  • Fax: 504-456-3113
Mailing address:
  • Phone: 504-887-7660
  • Fax: 504-887-7816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number017686
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: