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General NPI Number Information
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NPI Number | 1679309199
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Entity Type | Organization
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Legal Business Name | TYSON D HALE, MD PLLC
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Dates
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Enumeration Date | 09/11/2024
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Last Update Date | 09/11/2024
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Provider Practice Location Address
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Address Line | 164 INSPIRATION LOOP
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City | FREDERICKSBURG
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State | TX
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Zip | 78624-8409
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Country | US
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Telephone | 210-218-2237
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Fax | 830-896-5211
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Provider Business Mailing Address
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Address Line | PO BOX 293531
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City | KERRVILLE
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State | TX
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Zip | 78029-3531
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Country | US
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Telephone | 830-257-8484
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Fax | 830-896-5211
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Authorized Official
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Title or Position | MD-OWNER
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Name | TYSON D HALE
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Credential | MD
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Telephone | 210-218-2237
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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