Healthcare Provider Details

I. General information

NPI: 1578666491
Provider Name (Legal Business Name): WILLIAM R. HALE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 11/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 N ORANGE GROVE AVE
POMONA CA
91767-3006
US

IV. Provider business mailing address

1800 N ORANGE GROVE AVE
POMONA CA
91767
US

V. Phone/Fax

Practice location:
  • Phone: 909-623-8547
  • Fax: 909-623-3644
Mailing address:
  • Phone: 909-623-8547
  • Fax: 909-623-3644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number0C26646
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number0C26646
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: