Healthcare Provider Details

I. General information

NPI: 1992027023
Provider Name (Legal Business Name): MR. ROBERT EARL HALE III
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2010
Last Update Date: 02/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12604 WOODRUFF DR
COLORADO SPRINGS CO
80921-5700
US

IV. Provider business mailing address

PO BOX 909
COLORADO SPRINGS CO
80901-0909
US

V. Phone/Fax

Practice location:
  • Phone: 719-237-4086
  • Fax:
Mailing address:
  • Phone: 719-576-4171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: