Provider Demographics
NPI:1245226372
Name:HALE, MARSHALL T (MD)
Entity Type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:T
Last Name:HALE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1602 W LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62650-1007
Mailing Address - Country:US
Mailing Address - Phone:217-243-7200
Mailing Address - Fax:217-243-6165
Practice Address - Street 1:1602 W LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650-1007
Practice Address - Country:US
Practice Address - Phone:217-243-7200
Practice Address - Fax:217-243-6165
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-23
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD15274Medicare UPIN