Provider Demographics
NPI:1922267350
Name:PATRICK D HALEY, M.D., P.C.
Entity Type:Organization
Organization Name:PATRICK D HALEY, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:D
Authorized Official - Last Name:HALEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-321-1295
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19270174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04006938Medicaid
COC37811Medicare PIN
COD23573Medicare UPIN