Healthcare Provider Details

I. General information

NPI: 1043282247
Provider Name (Legal Business Name): DONALD D HALES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 03/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1485 N TURQUOISE DR SUITE 200
FLAGSTAFF AZ
86001-1398
US

IV. Provider business mailing address

1746 N BLUE SPRUCE CIR
FLAGSTAFF AZ
86001-1391
US

V. Phone/Fax

Practice location:
  • Phone: 928-774-7757
  • Fax: 928-774-7767
Mailing address:
  • Phone: 928-774-7757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number17804
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number17804
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number17804
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: