Healthcare Provider Details

I. General information

NPI: 1104106053
Provider Name (Legal Business Name): JAMIE HALE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2011
Last Update Date: 03/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5365 SPINE RD SUITE C
BOULDER CO
80301-3324
US

IV. Provider business mailing address

5365 SPINE RD SUITE C
BOULDER CO
80301-3324
US

V. Phone/Fax

Practice location:
  • Phone: 303-530-9325
  • Fax:
Mailing address:
  • Phone: 303-530-9325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberUO2792
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberDR.0054751
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberDR.0054751
License Number StateCO

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: