Provider Demographics
NPI:1467471367
Name:DOAK, HALEY E (PAC)
Entity Type:Individual
Prefix:MRS
First Name:HALEY
Middle Name:E
Last Name:DOAK
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 CHAPMAN ST
Mailing Address - Street 2:
Mailing Address - City:DAMARISCOTTA
Mailing Address - State:ME
Mailing Address - Zip Code:04543-4614
Mailing Address - Country:US
Mailing Address - Phone:207-563-6623
Mailing Address - Fax:207-563-6625
Practice Address - Street 1:68 CHAPMAN ST
Practice Address - Street 2:
Practice Address - City:DAMARISCOTTA
Practice Address - State:ME
Practice Address - Zip Code:04543-4614
Practice Address - Country:US
Practice Address - Phone:207-563-6623
Practice Address - Fax:207-563-6625
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA-888363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q57248Medicare UPIN