Provider Demographics
NPI:1609013259
Name:FAUST, HALLEY SPENCER (MD)
Entity Type:Individual
Prefix:
First Name:HALLEY
Middle Name:SPENCER
Last Name:FAUST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 VALLECITA DR
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-8803
Mailing Address - Country:US
Mailing Address - Phone:505-988-1360
Mailing Address - Fax:
Practice Address - Street 1:1260 VALLECITA DR
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-8803
Practice Address - Country:US
Practice Address - Phone:505-988-1360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-18
Last Update Date:2009-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2004-07812083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine