Healthcare Provider Details

I. General information

NPI: 1205799525
Provider Name (Legal Business Name): MATTHEW HALE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 HIGHWAY 62 W
BERTRAND MO
63823-9784
US

IV. Provider business mailing address

701 HIGHWAY 62 W
BERTRAND MO
63823-9784
US

V. Phone/Fax

Practice location:
  • Phone: 573-444-1441
  • Fax:
Mailing address:
  • Phone: 573-444-1441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: