Individual
JACK M. HALEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2000 N. BOISE AVE., LOVELAND, CO 80538-7282
(970) 635-4071
(303) 306-7753
Mailing address
P.O. BOX 173817, DENVER, CO 80217-8643
(303) 306-7783
(303) 306-7753
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
735
CO
363A00000X
Physician Assistant
Primary
PA.000735
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
55625029
—
CO
01
—
P01331724
RAILROAD MEDICARE
CO
Enumeration date
02/28/2006
Last updated
07/31/2015
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