Provider Demographics
NPI:1093121881
Name:LOOFBOURROW, HALE (MD)
Entity Type:Individual
Prefix:
First Name:HALE
Middle Name:
Last Name:LOOFBOURROW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 LAKE OTIS PKWY STE 322
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5231
Mailing Address - Country:US
Mailing Address - Phone:907-562-1234
Mailing Address - Fax:907-677-2007
Practice Address - Street 1:4100 LAKE OTIS PKWY STE 322
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508
Practice Address - Country:US
Practice Address - Phone:907-562-1234
Practice Address - Fax:907-677-2007
Is Sole Proprietor?:No
Enumeration Date:2014-07-01
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK8307207Q00000X
AK124361207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1093121881Medicaid