=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669406260
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HALE E HEDLEY MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2006
-----------------------------------------------------
Last Update Date | 11/20/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6817 SOUTHPOINT PKWY STE 1704 #1704
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32216-6298
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-222-8500
-----------------------------------------------------
Fax | 800-388-0270
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6817 SOUTHPOINT PKWY STE 1704 #1704
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32216-6298
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-222-8500
-----------------------------------------------------
Fax | 800-388-0270
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | ME94099
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | ME94099
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------