Healthcare Provider Details

I. General information

NPI: 1215974258
Provider Name (Legal Business Name): PAUL MCHALE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 07/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 S DOBSON RD
CHANDLER AZ
85224-5605
US

IV. Provider business mailing address

421 E MOUNTAIN SAGE DR
PHOENIX AZ
85048-1821
US

V. Phone/Fax

Practice location:
  • Phone: 480-917-1648
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number26121
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number26121
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License Number26121
License Number StateAZ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierAZ0736120
Identifier TypeOTHER
Identifier StateAZ
Identifier IssuerBC/BS
# 2
Identifier422874-09
Identifier TypeMEDICAID
Identifier StateAZ
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: