Provider Demographics
NPI:1245471085
Name:HALEY DERMATOLOGY & SKIN CARE CENTER, P.C.
Entity type:Organization
Organization Name:HALEY DERMATOLOGY & SKIN CARE CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DERMATOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:TARA
Authorized Official - Last Name:HALEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-954-5662
Mailing Address - Street 1:16935 6450 RD
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81403-7868
Mailing Address - Country:US
Mailing Address - Phone:808-954-5662
Mailing Address - Fax:
Practice Address - Street 1:3480 WOLVERINE DR
Practice Address - Street 2:SUITE F
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-4965
Practice Address - Country:US
Practice Address - Phone:808-954-5662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-06
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty