Healthcare Provider Details

I. General information

NPI: 1063617264
Provider Name (Legal Business Name): DALE G. HALTER, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 FROSTWOOD DR SUITE 208
HOUSTON TX
77024-2420
US

IV. Provider business mailing address

902 FROSTWOOD DR SUITE 208
HOUSTON TX
77024-2420
US

V. Phone/Fax

Practice location:
  • Phone: 713-266-1946
  • Fax: 713-467-7432
Mailing address:
  • Phone: 713-266-1946
  • Fax: 713-467-7432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberG1029
License Number StateTX

VIII. Authorized Official

Name: DR. DALE G. HALTER
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 713-266-1946