Provider Demographics
NPI:1235123852
Name:HALE, THOMAS L (DPM)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:L
Last Name:HALE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W GUADALUPE RD
Mailing Address - Street 2:SUITE 318
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-3335
Mailing Address - Country:US
Mailing Address - Phone:480-813-1815
Mailing Address - Fax:480-813-8836
Practice Address - Street 1:201 W GUADALUPE RD
Practice Address - Street 2:SUITE 318
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-3335
Practice Address - Country:US
Practice Address - Phone:480-813-1815
Practice Address - Fax:480-813-8836
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDPM192213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0066070OtherBCBS OF AZ
AZDPM192OtherLICENSE #
AZ1Z0425OtherHEALTHNET
AZ3352132-004OtherCIGNA HEALTHCARE
AZ3352132-004OtherCIGNA HEALTHCARE
AZDPM192OtherLICENSE #
AZ480001430Medicare ID - Type UnspecifiedRAILROAD MEDICARE
AZAZ0066070OtherBCBS OF AZ