Healthcare Provider Details

I. General information

NPI: 1760485890
Provider Name (Legal Business Name): GREGORY A HALE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 09/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 5TH ST S 3RD FLOOR
ST PETERSBURG FL
33701-4804
US

IV. Provider business mailing address

601 5TH ST S 3RD FLOOR
ST PETERSBURG FL
33701-4804
US

V. Phone/Fax

Practice location:
  • Phone: 727-767-4176
  • Fax: 727-767-4379
Mailing address:
  • Phone: 727-767-4176
  • Fax: 727-767-4379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberME103101
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: