Provider Demographics
NPI:1083617310
Name:HALTER, DALE G (MD)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:G
Last Name:HALTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:902 FROSTWOOD DR
Mailing Address - Street 2:STE 208
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2426
Mailing Address - Country:US
Mailing Address - Phone:713-266-1946
Mailing Address - Fax:713-467-7432
Practice Address - Street 1:902 FROSTWOOD DR
Practice Address - Street 2:STE 208
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2426
Practice Address - Country:US
Practice Address - Phone:713-266-1946
Practice Address - Fax:713-467-7432
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG1029207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00RD39Medicare ID - Type Unspecified
TXB23271Medicare UPIN