Provider Demographics
NPI:1063493716
Name:HALEY, HEATHER R (MD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:R
Last Name:HALEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:202 ROCK CREEK PARKWAY
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-3349
Practice Address - Country:US
Practice Address - Phone:251-928-3844
Practice Address - Fax:251-928-3353
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL22797207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051516754OtherBLUE CROSS PROVIDER NO
AL051516754OtherBLUE CROSS PROVIDER NO
AL051553779Medicare ID - Type Unspecified