MEDICARE: BRIAN ELLIOTT 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
1	207V00000X	Obstetrics & Gynecology Physician	01057598B	IN
2	207V00000X	Obstetrics & Gynecology Physician	ME122922	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	IH826Z	OTHER	FL	MEDICARE

General Provider Information

NPI Number	:	1245230515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN ELLIOTT HALEY MD

Provider Business Mailing Address
First Line	:	8180 NW 125TH LN
Second Line	:
City	:	PARKLAND
State	:	FL
Zip	:	33076-4964
Country	:	US
Telephone Number	:	260-458-4225
Fax Number	:

Provider Business Practice Location Address
First Line	:	7301A W PALMETTO PARK RD STE 305A
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33433-3466
Country	:	US
Telephone Number	:	561-372-9161
Fax Number	:	877-651-1244

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	06/28/2023

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Directions to “ BRIAN ELLIOTT HALEY MD” Practice Location

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