Provider Demographics
NPI:1366450116
Name:HALE, MAURICE J (MD)
Entity Type:Individual
Prefix:DR
First Name:MAURICE
Middle Name:J
Last Name:HALE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4910 VAN NUYS BLVD
Mailing Address - Street 2:STE 108
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-1757
Mailing Address - Country:US
Mailing Address - Phone:818-548-8333
Mailing Address - Fax:818-548-7888
Practice Address - Street 1:800 S CENTRAL AVE
Practice Address - Street 2:SUITE 100B
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-4370
Practice Address - Country:US
Practice Address - Phone:818-548-8333
Practice Address - Fax:818-548-7888
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2020-09-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG846872085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG84687Medicare ID - Type Unspecified
H20333Medicare UPIN