Provider Demographics
NPI:1184688962
Name:HALE, DENNIS M (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:M
Last Name:HALE
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 1:1850 59TH ST W
Mailing Address - Street 2:BLAKE PARK STE B
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209
Mailing Address - Country:US
Mailing Address - Phone:941-792-4993
Mailing Address - Fax:941-795-2905
Practice Address - Street 1:1850 59TH ST W
Practice Address - Street 2:BLAKE PARK STE B
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209
Practice Address - Country:US
Practice Address - Phone:941-792-4993
Practice Address - Fax:941-795-2905
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0036480207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL160011830OtherRAILROAD MEDICARE
FL41171OtherBCBS
FL41171OtherBCBS
FLD54714Medicare UPIN