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NPI Code Detail

MEDICARE: DR. HEATHER R HALEY MD

MEDICARE: DR. HEATHER R HALEY MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207N00000XDermatology Physician22797AL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1051516754OTHERALBLUE CROSS PROVIDER NO

General Provider Information

NPI Number : 1063493716
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. HEATHER R HALEY MD
Provider Business Mailing Address
First Line : 801 YORK ST
Second Line :
City : MANITOWOC
State : WI
Zip : 54220-4630
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 202 ROCK CREEK PARKWAY
Second Line :
City : FAIRHOPE
State : AL
Zip : 36532-3349
Country : US
Telephone Number : 251-928-3844
Fax Number : 251-928-3353
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/09/2005
Last Update Date : 11/09/2023

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Directions to “ DR. HEATHER R HALEY MD” Practice Location

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