Healthcare Provider Details

I. General information

NPI: 1790885358
Provider Name (Legal Business Name): DOUGLAS S HALE DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2006
Last Update Date: 04/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 BROADWAY STE 220
SEATTLE WA
98122-5373
US

IV. Provider business mailing address

600 BROADWAY STE 220
SEATTLE WA
98122-5395
US

V. Phone/Fax

Practice location:
  • Phone: 206-344-3808
  • Fax: 206-860-0907
Mailing address:
  • Phone: 206-344-3808
  • Fax: 206-860-0907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberP427
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: