MEDICARE: DR. BRIAN D HALE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	ME67771	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457355059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN D HALE M.D.

Provider Business Mailing Address
First Line	:	12109 COUNTY ROAD 103
Second Line	:
City	:	OXFORD
State	:	FL
Zip	:	34484-2951
Country	:	US
Telephone Number	:	352-205-8981
Fax Number	:	352-391-6498

Provider Business Practice Location Address
First Line	:	35095 US HIGHWAY 19 N
Second Line	:	STE 202
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-1971
Country	:	US
Telephone Number	:	727-771-0600
Fax Number	:	727-781-9666

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	02/02/2021

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