Provider Demographics
NPI:1619916210
Name:HALEY, PATRICK D (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:D
Last Name:HALEY
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 1:4545 E 9TH AVE
Mailing Address - Street 2:SUITE 380
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-3901
Mailing Address - Country:US
Mailing Address - Phone:303-321-1295
Mailing Address - Fax:303-320-1641
Practice Address - Street 1:4545 E 9TH AVE
Practice Address - Street 2:SUITE 380
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-3901
Practice Address - Country:US
Practice Address - Phone:303-321-1295
Practice Address - Fax:303-320-1641
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19270174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01192707Medicaid
CO01192707Medicaid
COD23573Medicare UPIN