Basic Information
| Provider Information | |||||||||
| NPI: | 1871733188 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HALEY | ||||||||
| FirstName: | CLINTON | ||||||||
| MiddleName: | CHRISTOPHER | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3409 WORTH ST | ||||||||
| Address2: | SUITE 710 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752462029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2148232533 | ||||||||
| FaxNumber: | 2148248679 | ||||||||
| Practice Location | |||||||||
| Address1: | 3409 WORTH ST | ||||||||
| Address2: | SUITE 710 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752462029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2148232533 | ||||||||
| FaxNumber: | 2148248679 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2009 | ||||||||
| LastUpdateDate: | 02/26/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | L6415 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
No ID Information.