Provider Demographics
NPI:1780978601
Name:HALDEOS, DEMITRIS P (MD)
Entity type:Individual
Prefix:
First Name:DEMITRIS
Middle Name:P
Last Name:HALDEOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 BRAMHALL ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-3134
Mailing Address - Country:US
Mailing Address - Phone:207-662-7060
Mailing Address - Fax:207-662-7066
Practice Address - Street 1:3223 1ST AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98134-1850
Practice Address - Country:US
Practice Address - Phone:207-662-7060
Practice Address - Fax:207-662-7066
Is Sole Proprietor?:No
Enumeration Date:2011-06-08
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60628117208D00000X, 2083P0500X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program