Healthcare Provider Details

I. General information

NPI: 1609013259
Provider Name (Legal Business Name): HALLEY SPENCER FAUST MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2009
Last Update Date: 01/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 VALLECITA DR
SANTA FE NM
87501-8803
US

IV. Provider business mailing address

1260 VALLECITA DR
SANTA FE NM
87501-8803
US

V. Phone/Fax

Practice location:
  • Phone: 505-988-1360
  • Fax:
Mailing address:
  • Phone: 505-988-1360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberMD2004-0781
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: