Healthcare Provider Details

I. General information

NPI: 1740333574
Provider Name (Legal Business Name): CAROLYN I HALE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 INLAND SHORES WAY N STE 202
KEIZER OR
97303-3884
US

IV. Provider business mailing address

5900 INLAND SHORES WAY N STE 202
KEIZER OR
97303-3884
US

V. Phone/Fax

Practice location:
  • Phone: 503-463-6799
  • Fax:
Mailing address:
  • Phone: 503-463-6799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD10836
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: