Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | R4974 | TX |
N | 208200000X | Surgeon | BP10057604 | TX |
N | 208600000X | Surgeon | BP10057604 | TX |
NPI | 1013368851 |
---|---|
Provider Name | Christopher Terrence Haley |
First Address | Temple, TX 76508-0001 |
Second Address | Temple, TX 76508-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2016 |
Last Update Date | 10/09/2019 |