1760485890 NPI number — DR. GREGORY A HALE MD

Table of content: DR. GREGORY A HALE MD (NPI 1760485890)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760485890 NPI number — DR. GREGORY A HALE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HALE
Provider First Name:
GREGORY
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760485890
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/25/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 5TH ST S
Provider Second Line Business Mailing Address:
3RD FLOOR
Provider Business Mailing Address City Name:
ST PETERSBURG
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33701-4804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-767-4176
Provider Business Mailing Address Fax Number:
727-767-4379

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 5TH ST S
Provider Second Line Business Practice Location Address:
3RD FLOOR
Provider Business Practice Location Address City Name:
ST PETERSBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33701-4804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-767-4176
Provider Business Practice Location Address Fax Number:
727-767-4379
Provider Enumeration Date:
05/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2080P0207X , with the licence number:  ME103101 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 274936 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7609090 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100249681-00 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009912800 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100033230A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 422400000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000162400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00120827 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200362500A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 205027600 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3897713 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: Q31510 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0527655 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200236950A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 64315013 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1429660 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 136990001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 564238 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: GH59805 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".




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