Provider Demographics
NPI:1275529224
Name:HALEY, JENNIFER T (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:T
Last Name:HALEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3780 WOLVERINE DRIVE STE F
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-4965
Mailing Address - Country:US
Mailing Address - Phone:970-252-7444
Mailing Address - Fax:970-252-3446
Practice Address - Street 1:3480 WOLVERINE DR
Practice Address - Street 2:SUITE F
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-4965
Practice Address - Country:US
Practice Address - Phone:970-252-7444
Practice Address - Fax:970-252-3446
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO47465207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology