Provider Demographics
NPI:1205076544
Name:HALEY, EARL GREGORY (MD)
Entity type:Individual
Prefix:
First Name:EARL
Middle Name:GREGORY
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:ONE HEALTHY PLACE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PATASKALA
Mailing Address - State:OH
Mailing Address - Zip Code:43062
Mailing Address - Country:US
Mailing Address - Phone:740-348-1915
Mailing Address - Fax:740-348-1916
Practice Address - Street 1:ONE HEALTHY PLACE
Practice Address - Street 2:SUITE 102
Practice Address - City:PATASKALA
Practice Address - State:OH
Practice Address - Zip Code:43062
Practice Address - Country:US
Practice Address - Phone:740-348-1915
Practice Address - Fax:740-348-1916
Is Sole Proprietor?:No
Enumeration Date:2009-02-26
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.097774208M00000X
OH57014690207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist