1235123852 NPI number — THOMAS L HALE DPM

Table of content: THOMAS L HALE DPM (NPI 1235123852)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235123852 NPI number — THOMAS L HALE DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HALE
Provider First Name:
THOMAS
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1235123852
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 W GUADALUPE RD
Provider Second Line Business Mailing Address:
SUITE 318
Provider Business Mailing Address City Name:
GILBERT
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85233-3335
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-813-1815
Provider Business Mailing Address Fax Number:
480-813-8836

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 W GUADALUPE RD
Provider Second Line Business Practice Location Address:
SUITE 318
Provider Business Practice Location Address City Name:
GILBERT
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85233-3335
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-813-1815
Provider Business Practice Location Address Fax Number:
480-813-8836
Provider Enumeration Date:
09/09/2005

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: 213ES0103X , with the licence number:  DPM192 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: AZ0066070 . This is a "BCBS OF AZ" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: DPM192 . This is a "LICENSE #" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1Z0425 . This is a "HEALTHNET" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 3352132-004 . This is a "CIGNA HEALTHCARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".