Provider Demographics
NPI:1124192927
Name:HALE, ROBIN RAND (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:RAND
Last Name:HALE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:R
Other - Middle Name:RAND
Other - Last Name:HALE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3001 DAGGETT AVE
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-1114
Mailing Address - Country:US
Mailing Address - Phone:541-274-8980
Mailing Address - Fax:
Practice Address - Street 1:3001 DAGGETT AVE
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-1114
Practice Address - Country:US
Practice Address - Phone:541-274-6699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD12370207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR229641Medicaid
OR229641Medicaid
OR106169Medicare ID - Type Unspecified