Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207KA0200X | Allergist | 148892 | NY |
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 148892 | NY |
NPI | 1255343984 |
---|---|
Provider Name | Douglas William Halliday |
First Address | Skaneateles, NY 13152-1196 |
Second Address | Skaneateles, NY 13152-1196 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2006 |
Last Update Date | 15/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B81215 | (02) | NY |